NTIS Limited Access Death Master Files (LADMF) Systems Safeguards Attestation Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NTIS FM100B NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Safeguards Attestation Forment Body Systems Safeguards Attestation Form	Form and Instruction	New	Available
Form NTIS FM100A NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form	Form and Instruction	New	Available
0692-XXXX-Emergency-NTIS-LADMF-AttestationForms-DRAFT-NTIS-1_SORN_v0-6.docx	Supplementary Document	Uploaded 2017-01-04	Available
0692-XXXX-Emergency-NTIS-LADMF-AttestationForms-DRAFT-DMF-Cert-PIA_v0-4.docx	Supplementary Document	Uploaded 2017-01-04	Available
0692-XXXX-NTIS-LADMF-AttestationForms-EmergencyJustificationLetter-NTIS-To-OIRA-11-23-16.pdf	Supplementary Document	Uploaded 2016-11-29	Available
0692-XXXX-NTIS-LADMF-AttestationForms-EmergencyJustificationLetter-NTIS-To-DOC-11-23-16.pdf	Supplementary Document	Uploaded 2016-11-29	Available
0692-XXXX-Emergency-NTIS-LADMF-AttestationForms-SupportingStatement-1-4-17.docx	Supporting Statement A	Uploaded 2017-01-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224604	NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Attestation Formsttestation Form	Form and Instruction	New	NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Safeguards Attestation Forment Body Systems Safeguards Attestation Form
224602	NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form	Form and Instruction	New	NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form

ICR Details

OMB Control No: 0692-0016	ICR Reference No: 201611-0692-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOC/NTIS	Agency Tracking No: DY
Title: NTIS Limited Access Death Master Files (LADMF) Systems Safeguards Attestation Forms
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/21/2016
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/05/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/02/2016
Terms of Clearance: This collection is approved for six months only. If the Department plans to use this collection for more than 6 months, the collection must go through a regular 60 and 30 day comment process. Also, if this collection is resubmitted, the SORN and PIA must be part of the package.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	6 Months From Approved
Responses	560	0	0
Time Burden (Hours)	1,680	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Technical Information Service respectfully requests an expedited review and approval of this information collection for the following reason: Section 203 of the Bipartisan Budget Act of 2013 prohibits disclosure of Limited Access Death Master File (Limited Access DMF) information, as detailed in this supporting statement and the cover memorandum, unless a person has been certified for access pursuant to certain criteria in a program established by the Secretary of Commerce, who has delegated that responsibility to the Director of NTIS. NTIS issued a final rule establishing a certification program, which becomes effective November 28, 2016, replacing and superseding the interim final rule now in effect. The final rule contains new requirements for certification, including the submission with a person’s application of a written attestation from an “Accredited Conformity Assessment Body” (ACAB) that the person meets the safeguarding requirements of the final rule for the protection of Limited Access DMF information. A state or local government Auditor General (AG) or Inspector General (IG) may submit the written attestation for a state or local government department or agency seeking certification or renewal if the AG or IG is a department or agency of the same state or local government. The forms are to be used by ACABs and state and local AGs and IGs attesting on the behalf of the applicants. Many businesses and other organizations, including credit card companies, financial institutions, health and life insurance companies, medical and health care, as well as state and local government departments and agencies, rely upon uninterrupted access to the Limited Access DMF. If the information collection is not available for use under the final rule, NTIS will not be able to implement the final rule. This could result in such persons who require a renewal of certification not being able to be recertified and experience a disruption in access.

Emergency Justfication: Related to the implementation of Section 203 of the Bipartisan Budget Act of 2013, Pub. L. 113-67 (Act), the ACT prohibits disclosure of information from the Social Security Administration's (SSA) Death Master File (DMF) during the three-year-calendar-year period following an individual's death (referred to as "Limited Access DMF"), unless the person requesting the information has been certified under a program established by the Secretary of Commerce (Secretary). The Secretary delegated the authority to carry out Section 203 of the Act to the Director of NTIS. NTIS issued a final rule establishing a certification program for Limited Access DMF that becomes effective on November 28, 2016, replacing and superseding the interim rule currently in place. The forms can not be used until OMB approval is received.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 86703	12/01/2016
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
NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form	NTIS FM100A	NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form
NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Attestation Formsttestation Form	NTIS FM100B	NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Safeguards Attestation Forment Body Systems Safeguards Attestation Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	560	0	0	560	0	0
Annual Time Burden (Hours)	1,680	0	0	1,680	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $294,000

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: 12/02/2016

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