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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)
OMB: 0692-0013
IC ID: 224474
OMB.report
DOC/NTIS
OMB 0692-0013
ICR 202603-0692-001
IC 224474
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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
FM 101
Application Form for Firewalled Status
FM 101_LADMF ACAB Application Form for Firewalled Status Fillable Form_updated 10.3.2025.pdf
Yes
Yes
Fillable Fileable
Form
FM 161
LADMF Certification Form
FM 161_Limited Access Death Master File Certification Fillable Form_updated 10.3.2025.pdf
Yes
Yes
Fillable Fileable
Form
Form 100A
Safeguards Attestation Froms
FM 100A_Accredited Conformity Assessment Body Systems Safeguards Attestation Fillable Form_updated 10.3.2025.pdf
Yes
Yes
Fillable Fileable
Form
Form 100B
Systems Safeguards Attetations for State and Local AGs and IGS
Systems Safeguards Attestations for State and Local AGs and IGs - 10 2025.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
260
0
0
0
0
260
Annual IC Time Burden (Hours)
780
0
0
0
0
780
Annual IC Cost Burden (Dollars)
0
0
0
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.
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