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OMB Control No: 0920-0215	ICR Reference No: 202609-0920-003
Status: Received in OIRA	Previous ICR Reference No: 202301-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0271
Title: [NCHS] Application Form and Related Forms for the Operation of the National Death Index
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/14/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	3,026	0
Time Burden (Hours)	1,373	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	3,026	2,362	664
Annual Time Burden (Hours)	1,373	1,333	40
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a reinstatement of a previously approved collection for three years of approaval and 1374 annual burden hours.

Annual Cost to Federal Government: $133,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Odion Clunis 770 488-0045 lta2@cdc.gov

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