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Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of Revenue(5) Rich McCoy, Director of the Center for Health Statistics at the Vermont Department of Health,and President-Elect of the National Association of Public Health Statistics and InformationSystems(6) Andrea Price, National Association of Public Health Statistics and Information Systems(7) Steven Schwartz, Registrar of the Bureau of Vital Statistics at the New York City Department ofHealth and Mental Hygiene(8) Anthony Stout, National Association of Public Health Statistics and Information Systems(9) Shawna Webster, Executive Director, National Association of Public Health Statistics andInformation SystemsFindingsOverview of birth and death registrationFigures 1 and 2 provide overviews of the birth and death registration processes, respectively. Bothfigures show the process of gathering information about the vital event on the left, including the typesof people and organizations involved in the process. The middle panels depict the roles of stategovernment in registering the vital event and providing data about vital events to various state andnational users. The right panels depict major national agencies and organizations that compile, use, anddistribute birth and death records obtained from state vital records offices. The figures also depictpayments made by various users of vital records to state or national organizations for the use of therecords. 2January 2018Page 6 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueFigure 1. Current birth registration process for a state vital records jurisdictionLegend for Figure 1:–––– Solid black and green lines denote typical processes and payments, respectively- - - - Dashed black and green lines denote other, less common processes and payments, respectively2Payments by users to providers of vital records or vital statistics data are shown by green lines with “ ”.DMV Department of Motor VehiclesEAB Enumeration at BirthEBRS Electronic Birth Registration SystemEHR-S Electronic Health Record SystemEVVE Electronic Verification of Vital EventsIIS Immunization Information SystemNBS Newborn ScreeningNCHS National Center for Health StatisticsOB Obstetrician or comparable health care providerJanuary 2018Ped PediatricianSAMS Secure Access Management ServicesSHD State Health DepartmentSSA Social Security AdministrationSSN Social Security NumberSTEVE State and Territorial Exchange of Vital Events SystemVRS Vital Registration SystemVSCP Vital Statistics Cooperative ProgramPage 7 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueFigure 2. Current death registration process for a state vital records jurisdictionLegend for Figure 2:–––– Solid black and green lines denote typical processes and payments, respectively- - - - Dashed black and green lines denote other, less common processes and payments, respectivelyCMS Centers for Medicare and Medicaid ServicesCR Cancer RegistryDMF Death Master FileDMV Department of Motor VehiclesDoD U.S. Department of DefenseDoS U.S. Department of StateED Emergency DepartmentEDRS Electronic Death Registration SystemEHR-S Electronic Health Record SystemEVVE Electronic Verification of Vital EventsEVVE FOD Electronic Verification of Vital Events Fact of DeathIIS Immunization Information SystemLADMF Limited Access Death Master FileME/C Medical Examiner / CoronerNCHS National Center for Health StatisticsNDI National Death IndexNTIS National Technical Information ServiceNVDRS National Violent Death Reporting SystemSAMS Secure Access Management ServicesSHD State Health DepartmentSSA Social Security AdministrationSTEVE State and Territorial Exchange of Vital Events SystemVRO Vital Records OfficeVRS Vital Registration SystemVSCP Vital Statistics Cooperative ProgramUses and users of identified birth and death recordsUses and users of identified 3 birth and death records are shown in Tables 1 and 2, respectively. Theseuses and users include individuals who use their birth certificate to establish their identity for variouslegal and administrative purposes; the Social Security Administration (SSA), which uses birth data tofacilitate the issuance of Social Security Numbers (SSN) to persons born in the United States and deathdata to terminate the payment of benefits; and private organizations, which use death data to paybenefits and to prevent fraud.“Identified records” refers to one or more of records, each of which contains information sufficient to identity thesubject of the record, such as name, name of mother, and location and date of birth on a birth record.3January 2018Page 8 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueThese identified birth and death records are available through state and other vital records offices(VROs) to authorized individuals, who usually must pay a fee for copies or use of the records.Verification of birth and death records is also available to authorized users for all state and other vitalrecords jurisdictions—except New York and Texas—through the Electronic Verification of Vital Events(EVVE) system, which is maintained by the National Association of Public Health Statistics andInformation Systems (NAPHSIS). NAPHSIS also operates the Electronic Verification of Vital Events Fact ofDeath (EVVE FOD) system, which provides authorized users with the ability to discover if a death recordexists for an individual. Currently, 42 states and jurisdictions participate in the EVVE FOD system. (SeeAppendix C and Table 5.)The Social Security Administration purchases identified birth and death records from VROs to administerits benefits programs. These records form a part of the NUMIDENT electronic database, which containsSSA’s records of Social Security Numbers (SSN) assigned to individuals since 1936. The SSA compiles itsdeath information in the Death Master File (DMF), which is an extract of death information onNUMIDENT (see Appendix C). The DMF includes, if available, each deceased individual’s SSN, first name,middle name, surname, date of birth, and date of death. The SSA provides access to the “full” DMF for a“reasonable cost” to Federal or state agencies that provide federally funded benefits to individuals. TheSSA may also provide State driver’s license agencies with access to its records to verify applicableinformation “pursuant to the Help America Vote Act of 2002.” (See Appendix C and Table 5.)A “public” version of the DMF contains death records extracted from the NUMIDENT database, butdoes not include death data received from the states. The “public” version of the DMF is available fromthe Department of Commerce’s National Technical Information Service (NTIS) as the “Limited AccessDMF,'' or “LADMF,” to certified persons and organizations, who must have a legitimate fraud preventioninterest, or have a legitimate business purpose pursuant to a law, governmental rule, regulation, orfiduciary duty. The NTIS charge fees for using the LADMF and to cover the costs associated with itscertification program. (See Appendix C and Table 5.)NCHS established and maintains the National Death Index (NDI), a centralized database of death recordinformation on file in state vital statistics offices, as a resource to aid epidemiologists and other healthand medical investigators with their mortality ascertainment activities. Researchers pay a fee for usingthe NDI and can request either a routine NDI search for those who do not need cause of death codes, oran NDI Plus search, which also provides cause of death codes. (See Appendix C and Table 5.)Table 1. Uses of identified birth records and data setsUseIndividual or FamilyEstablish identity for legaland administrative purposesUser(s)SystemIndividual or familyObtain or renew U.S.PassportIndividual or familyProvide proof of citizenshipor legal residency foremploymentIndividual personState andjurisdictionVROsState andjurisdictionVROsState andjurisdictionVROsJanuary 2018RecordsusedVRO Fundingsource1Sale ofcertificate1Sale ofcertificate1Sale ofcertificatePage 9 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueVerify identity for driverslicense or identity cardIndividual personVerify age of child for sportsleagueIndividual or familyProvide proof of country ofbirth for college admissionIndividual personFederal GovernmentVerify and certify birthinformationIssue Social Security Number(SSN) to each newborn toprevent other parties fromfiling a request for a SSN inthe name of the newbornObtain or renew U.S.PassportState andjurisdictionVROsState andjurisdictionVROsState andjurisdictionVROs1Sale ofcertificate1Sale ofcertificate1Sale ofcertificateSSADoS/DiplomaticSecurityOPMRegional FBI OfficesDHS/USCISSSAEVVE*EVVE*1 to many1 to manyUser feeUser feeEVVE*EVVE*EVVE*State andjurisdictionEBRS1 to many1 to many1 to manyAll birthsUser feeUser feeUser feeSSA contractswith StateVROsDoS/Passport ServicesFraud PreventionOfficesState andjurisdictionVROsEVVE*State andjurisdictionVROs1 to manyUnknown†1 to many1 to manyUser feeCMScontractorpayments toVRONCHS (VSCP)Conduct evaluations of stateMedicaid programsCMSObtain birth certificatedemographic and medicaldata for the National VitalStatistics SystemState and Local GovernmentAssist state and localgovernment agencies inperforming their officialduties*Enroll eligible children intoMedicaid programNCHSState andjurisdictionEBRSAll birthsSecretary of StateEVVE*SelectedbirthsUser feeState MedicaidprogramsSelectedbirthsUnknown†Verify identity for driver’slicense or identity cardDMVState andjurisdictionVRO/EBRSEVVE*State andjurisdictionVROsEVVE*SSA birth fileVerify birth for voterJanuary 2018DMVSelectedbirthsSelectedUser feeUnknown†User feeNone: BirthPage 10 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueregistrationInitialize entry inImmunization InformationSystem (IIS)Facilitate newborn screeningfor health disordersState IISHealth care providerresponsible forscreening newbornPrivate (Non-Government) OrganizationsGenealogical researchIndividual person ororganizationVerify age of child for sportsleagueSport leagueUse by media to verifyidentity or other informationMedia organizationsUse of birth data for medicalor other health researchMedical and otherhealth researchersConduct background checksfor government agencies,pension funds, or otherorganizations (Note: Somestates can’t providecertificates to these thirdparties.)Determine property rightsand place them in landrecordsMarketing products toparents of newborns. (Note:Some states can refuse theserequests.)Company undercontract togovernment agency orpension fund (e.g.,Berwyn Group)Title search companiesMarketing companiesstates andbirthsAlldata obtainedfrom SSAUnknown†AllUnknown†State andjurisdictionVROsState andjurisdictionVROsState andjurisdictionVROsState andjurisdictionVROsState andjurisdictionVROs1 to manySale ofcertificate(s)or VR dataSale ofcertificate(s)State andjurisdictionVROsState andjurisdictionVROs1 to manyState andjurisdictionEBRSState andjurisdictionVRO/EBRS1 to many1 to many1 to many1 to manyManySale ofcertificate(s)or VR dataSale ofcertificate(s)or VR dataSale ofcertificate(s)or VR dataSale ofcertificate(s)or VR dataSale ofcertificate(s)or VR data* For information on births occurring in states or jurisdictions not participating in EVVE, the user must contact thestate or jurisdiction’s VRO for information about birth records.† The author of this report was unable to find the information needed to fill in this cell in this table. The VROsource of funding may differ by jurisdiction.Sources of information for Table 1:(1) NAPHSIS: About EVVE FOD. Available at https://www.naphsis.org/evve-fod; accessed on 4 Oct2017.(2) Personal communication with Rich McCoy, Vermont State Registrar and Chief, Center for HealthStatistics, 13 Oct 2017.(3) Presentations at NCVHS hearing, September 11-12, 2017, Washington, D.C., available ing/; accessed on 4 OctJanuary 2018Page 11 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of Revenue2017.Table 2. Uses of identified death records and data setsUseIndividual or FamilyEstablish fact of death forlegal and administrativepurposes. Note: DeathCertificate cannot beprovided to funeraldirectors in all states.Federal GovernmentAssist federal governmentagencies in performing theirofficial duties (FederalAdministrative Use)*Establish fact and cause ofdeath to pay death benefit,or terminate paymentsunder retirement or otherbenefit programsEstablish fact of death toterminate, redirect, orotherwise modify SocialSecurity payments or otherbenefitsAssist federal governmentagencies in paying deathbenefits, or terminatingpayments under disability,unemployment, workers’compensation, pension,retirement, or other benefitprogramsJanuary 2018VRO FundingsourceUserSystemRecords usedFamily of decedentState andjurisdictionVROs1Purchase ofcertificate(s) byindividual,family, orfuneral directorEVVE FOD†EVVE FOD†EVVE FOD†EVVE FOD†EVVE FOD†EVVE FOD†Full DMF1 to many1 to many1 to many1 to many1 to many1 to manyActive dutymilitarydeathsUser feeUser feeUser feeUser feeUser feeUser feeNone: DMFobtained fromSSAVAFull DMF†Federal RetirementThrift InvestmentBoardOPMFull DMF†HUDUSDA/FSAUSDA/NRCSUSDA/RMASSAFull DMF†Full DMF†VeterandeathsDeaths offederal civilianand ��State andjurisdictionEDRSAll deathsSSA contractswith State VROsDoL/OWCPUnknown††Deaths ofcertain civilianemployeesUnknown††Examples of users:DHSDoSIRSNIOSHU.S. TreasuryVADoD/DefenseManpower DataCenterFull DMF†Page 12 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueUseEstablish fact of death toterminate benefitsVerify deaths of individualsto prevent tax fraud by useof identities of recentlydeceased individuals toclaim tax refundsIdentify and obtaininformation about deathsdue to specific causesIdentify health studysubjects who have diedIdentify health studysubjects who have died, ifresearcher can’t obtainrecords quickly enoughthrough NDI, or researchproposal is rejected by NDI,or researchers only needrecords from one or twostatesState and LocalGovernmentAssist state and localgovernment agencies inperforming their officialduties (State/localAdministrative Use)*Assist state and localgovernment agencies inpaying death benefits, orJanuary 2018SystemFull DMF†Full DMF†Pension BenefitGuarantyCorporationFull DMF†IRSFull DMF†CPSCState andjurisdictionVROsNDISelecteddeathsSale ofcertificatesAll deathsNDI user feesState andjurisdictionVROsSelecteddeathsSale ofcertificatesEVVE FOD†1 to manyUser fees paidby state andlocalgovernmentagenciesLADMF†1 to manyEVVE FOD†AllNone: NTIS UserfeesUser fees paidby state andlocalCDCCensus BureauCMSDoDNIHNIH or otherfederal agencyExamples of users:CountygovernmentDMVLaw enforcementSecretary of StateSocial servicesSee Appendix DState and localgovernmentpension plansRecords usedAll deathsDeaths ofrailroadworkers andtheir familiesDeaths ofpersonscovered byPBGCAll deathsVRO FundingsourceNone: DMFobtained fromSSAUserCMSU.S. RailroadRetirement BoardNone: DMFobtained fromSSAPage 13 of 52

Vital Records and Vital Statistics in the United States: Uses, Users, Systems, and Sources of RevenueVRO FundingsourcegovernmentagenciesUseUserterminating paymentsUnemploymentunder disability,programsunemployment, workers’Workers’compensation, pension,compensationretirement, or other benefit programprograms (State/localBenefit Use)Private (Non-Government) OrganizationsAssist financial institutionsExamples of users:in verifying legitimacy andCitigrouplegal ownership of financial Equifaxtransactions, such asFidelityinvestments, loans andNorthern Trustdeposits.Assist healthcareExamples of users:organizations inAscension Healthdetermining whetherTenet Healthcarepatients survive care and in Trinity Healthremoving decedents fromtheir files (HealthcareAdministrative Use)Determine property rightsTitle searchand enter them in landcompaniesrecordsEstablish fact and cause ofLife insurancedeath to pay benefitcompaniesSystemRecords usedEVVE FOD†EVVE FOD1 to manyEVVE FOD†1 to manyUser fees paidby health careorganizationsState andjurisdictionVROs1 to manySale ofcertificate(s)1Assist insurance companiesin identifying insuredindividuals who have died,providing warrantedbenefits to beneficiaries,and in complying withapplicable state lawsEstablish fact of death toterminate payments orother benefitsExamples of users:MetLifeState FarmSee Appendix DEVVE FOD†1 to manyNone:Certificateobtained fromdecedent’sfamilyUser feeLADMF†1 to manyNone: User feespaid to NTISEmployer-basedpension orretirement plansEVVE FOD†Selecteddeaths1 to

(6) Vital statistics consists of quantitative data concerning vital events in a population, such as the number of births and the death rate. Vital statistics are derived from an analysis of vital records data. Approach NCVHS contracted with R. Gibson Parrish, M.D., to prepare this report under the guidance of the NCVHS