Information Collection

Monthly Vital Statistics Report

IC 6670 under ICR 202203-0920-008 · OMB 0920-0213.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0213 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0213 Monthly Vital Statistics Report Form
0920-0213 Annual Vital Statistics Occurance Report Att C Monthly Form 5202020.docx Form
0920-0213 Annual Vital Statistics Occurance Report Att C Monthly Form 5202020.docx Form
Attachment E - Example Email Request.docx Example of Email Request IC Document
Attachment E - Example Email Request.docx Example of Email Request IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Monthly Vital Statistics Report	Agency IC Tracking Number:	0920-0213

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0213	Annual Vital Statistics Occurance Report	Att C Monthly Form 5202020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 91	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	91	-605	696
Annual IC Time Burden (Hours)	46	-47	93
Annual IC Cost Burden (Dollars)	300	-1,997	2,297

Documents for IC

Title	Document	Date Uploaded
Example of Email Request	Attachment E - Example Email Request.docx	05/13/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.