Information Collection

NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form

IC 224602 under ICR 201611-0692-002 · OMB 0692-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0692-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NTIS FM100A NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form	Form and Instruction
NTIS FM100A NTIS Limited Access Death Master File Accredited Conform 0692-XXXX-NTIS-LADMF-AttestationForm-NTIS-FM100A-11-28-16.pdf	Form and Instruction

IC Title:

NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	NTIS FM100A	NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form	0692-XXXX-NTIS-LADMF-AttestationForm-NTIS-FM100A-11-28-16.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: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

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.