Limited Access Death Master File Subscriber Certification Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NTIS FM100 Limited Access Death Master File (LADMF) Certification Systems Safeguards Attestation Form	Form	New	Available
Form NTIS FM161 Limited Access Death Master File Subscriber Certification Form	Form	New	Available
DMF supporting statement document for certificaton and attestation forms-12-19-14.doc	Supporting Statement A	Uploaded 2014-12-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214347	Limited Access Death Master File (LADMF) Certification Systems Safeguards Attestation Form	Form	New
214345	Limited Access Death Master File Subscriber Certification Form	Form	New

ICR Details

OMB Control No: 0692-0014	ICR Reference No: 201408-0692-003
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOC/NTIS	Agency Tracking No: DY
Title: Limited Access Death Master File Subscriber Certification Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule	Conclusion Date: 12/19/2014
	Date Received in OIRA: 09/02/2014
Terms of Clearance: Commerce must resubmit the collection instruments when the final rule is submitted for OMB review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Technical Information Service (NTIS) Limited Access Death Master File Subscriber Certification Form (Certification Form) is used by NTIS to collect information related to the implementation of Section 203 of the Bipartisan Budget Act of 2013 (Pub. L. 113-67) (Act).

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Authorizing Statute(s): PL: Pub.L. 113 - 67 203 Name of Law: Bipartisan Budget Act of 2013
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0692-AA21	Proposed rulemaking	79 FR 99999	08/31/2014

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Limited Access Death Master File Subscriber Certification Form	NTIS FM161	Limited Access Death Master File Subscriber Certification Form
Limited Access Death Master File (LADMF) Certification Systems Safeguards Attestation Form	NTIS FM100	Limited Access Death Master File (LADMF) Certification Systems Safeguards Attestation Form

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $220,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/02/2014

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