Information Collection

National Technical Information Service, Limited Access Death Master File (Derived from the Social Security Administration Death Master File) Subscriber Certification Form

IC 210702 under ICR 201403-0692-001 · OMB 0692-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0692-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NTIS FM161 National Technical Information Service, Limited Access Death Master File (Derived from the Social Security Administration Death Master File) Subscriber Certification Form	Form
NTIS FM161 Limited Access Death Master File DMF_certification_v19.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

National Technical Information Service, Limited Access Death Master File (Derived from the Social Security Administration Death Master File) Subscriber Certification Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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	DMF_certification_v19.pdf		Yes	Yes	Fillable Printable

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: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	1,400	1,400
Annual IC Cost Burden (Dollars)	140,000	140,000

Documents for IC

table that charts IC Documents
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.