NTIS Limited Access Death Master File Subscriber Certification Form

NTIS Limited Access Death Master File (LADMF) Certification Form (Derived from the Social Security Administration's Death Master File)

Documents and Forms

Document Name Document Type
Form NTIS FM161 NTIS Limited Access Death Master File Subscriber Certification Form Form
NTIS FM161 Limited Access Death Master File National Technical Info 0692-0013_FM161_Limited Access Death Master File Certification Fillable_Form-Fillable.pdf Form
NTIS FM161 Limited Access Death Master File National Technical Info 0692-0013_FM161_Limited Access Death Master File Certification Fillable_Form-Fillable.pdf Form

Information Collection (IC) Details

IC Title:	NTIS Limited Access Death Master File Subscriber Certification Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NTIS FM161	Limited Access Death Master File National Technical Information Service 5301 Shawnee Rd Alexandria, VA 22312-2312 Email: LADMFCert@ntis.gov Form Number: NTIS FM161 Certification Form	0692-0013_FM161_Limited Access Death Master File Certification Fillable_Form-Fillable.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 260	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	260	10	250
Annual IC Time Burden (Hours)	780	155	625
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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