NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Attestation Formsttestation Form

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form NTIS FM100B 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
NTIS FM100B NTIS Limited Access Death Master File (LADMF) State or L 0692-XXXX-NTIS-LADMF-AttestationForm-NTIS-FM100B-11-28-16.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Attestation Formsttestation 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	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	0692-XXXX-NTIS-LADMF-AttestationForm-NTIS-FM100B-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: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	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.