OMB control number

[NCHS] Application Form and Related Forms for the Operation of the National Death Index

OMB 0920-0215 · HHS/CDC.

OMB 0920-0215

The National Death Index (NDI) and the services it provides allows NCHS to collect mortality data to support epidemiological research and to furnish mortality information to approved public health and medical investigators. This is a Revision request for a three-year clearance to use of the administrative forms (the application form, repeat request form, and transmittal form) and the fee worksheets utilized in the operation of the National Death Index (NDI) program.

The latest form for [NCHS] Application Form and Related Forms for the Operation of the National Death Index expires 2026-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
NDI - Application Form (paper) Form and Instruction
NDI - Early Release Fee Worksheet Form and Instruction
NDI - Fee Worksheet Form and Instruction
NDI Early Relase Transmittal Form Form and Instruction
NDI - Application Form (electronic) Form and Instruction
NDI - Transmittal Form Form and Instruction
NDI - Repeat Request Form Form and Instruction
Att G IRB.pdf Supplementary Document
Att F National Death Index Advisors.docx Supplementary Document
Att B Published 60-Day FRN.pdf Supplementary Document
Att A Authorizing Legislation.docx Supplementary Document
NDI Sup St B_1_31_23.docx Supporting Statement B
NDI Sup St A_1_31_23_final_Final.docx Supporting Statement A
NDI - Application Form (paper) Form and Instruction
NDI - Early Release Fee Worksheet Form and Instruction
NDI - Fee Worksheet Form and Instruction
NDI Early Relase Transmittal Form Form and Instruction
NDI - Application Form (electronic) Form and Instruction
NDI - Transmittal Form Form and Instruction
NDI - Repeat Request Form Form and Instruction

All Historical Document Collections

202301-0920-012 Approved without change	Revision of a currently approved collection	2023-02-08
201912-0920-014 Approved without change	Reinstatement with change of a previously approved collection	2020-01-31
201903-0920-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-03-11
201610-0920-008 Approved without change	Revision of a currently approved collection	2016-10-14
201309-0920-006 Approved without change	Extension without change of a currently approved collection	2013-09-16
201010-0920-004 Approved without change	Extension without change of a currently approved collection	2010-10-12
200711-0920-012 Approved without change	Revision of a currently approved collection	2007-11-21
200409-0920-006 Approved without change	Extension without change of a currently approved collection	2004-09-27
200208-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2002-08-23
200109-0920-001 Approved without change	Extension without change of a currently approved collection	2001-09-13
199808-0920-003 Approved without change	Extension without change of a currently approved collection	1998-08-17
199506-0920-004 Approved without change	Extension without change of a currently approved collection	1995-06-23
199206-0920-002 Approved without change	Extension without change of a currently approved collection	1992-06-19
198905-0920-003 Approved without change	Revision of a currently approved collection	1989-05-15
198802-0920-009 Approved without change	Extension without change of a currently approved collection	1988-02-16

OMB Details

NDI - Application Form (paper)

Federal Enterprise Architecture: Health - Public Health Monitoring

Form n/a

National Death Index Application Form

Paper Only

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.