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 FM 100B NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Safeguards Attestation Form Systems Safeguards Attestation Form	Form and Instruction	New	Available
Form NTIS FM 100A NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form	Form and Instruction	New	Available
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	Removed	Available
Form NTIS FM100A NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form	Form and Instruction	Removed	Available
0692-0015-NTIS-Notes OMB NTIS CDIA 100417.docx	Supplementary Document	Uploaded 2017-10-06	Available
NTIS DMF PIA SAOP Approved 031517.pdf	Supplementary Document	Uploaded 2017-07-14	Available
5-24-2017_CDIA Comments to OMB_FM100A.pdf	Public Comments	Uploaded 2017-05-24	Repair queued
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
0692-0016-NTIS-LADMF-SystemsSafeguardsAttestationForms-SuportingStatemen_revised10-4-17_.docx	Supporting Statement A	Uploaded 2017-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225787	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 (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Safeguards Attestation Form Systems Safeguards Attestation Form
225787	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
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	Removed	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	Removed	NTIS Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form

ICR Details

OMB Control No: 0692-0016	ICR Reference No: 201702-0692-001
Status: Historical Active	Previous ICR Reference No: 201611-0692-002
Agency/Subagency: DOC/NTIS	Agency Tracking No: DY
Title: NTIS Limited Access Death Master Files (LADMF) Systems Safeguards Attestation Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/18/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/20/2017
Terms of Clearance: This collection is approved based on the revised materials provided by the Department.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	560	0	560
Time Burden (Hours)	1,680	0	1,680
Cost Burden (Dollars)	0	0	0

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Abstract: The National Technical Information Service (NTIS) Limited Access Death Master File Accredited Conformity Assessment Body Systems Safeguards Attestation Form (ACAB Systems Safeguards Attestation Form) and the Limited Access Death Master File State or Local Auditor General or Inspector General Systems Safeguard Attestation Form (AG or IG Systems Safeguards Attestation Form) are used to collect information related to the implementation of Section 203 of the Bipartisan Budget Act of 2013 (Pub. L. 113-67) (Act). Section 203 of the Act prohibits disclosure of Limited Access Death Master File (Limited Access DMF) information during the three-calendar-year period following death unless the person requesting the information has been certified under a program established by the Secretary of Commerce. The Act directs the Secretary of Commerce to establish a certification program for such access to the Limited Access DMF. The Secretary of Commerce has delegated the authority to carry out the DMF certification program to the Director, NTIS.

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 9991	02/09/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 18609	04/20/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

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) Accredited Conformity Assessment Body Systems Safeguards Attestation Form	NTIS FM 100A, NTIS FM 100B	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 Safeguards Attestation Form 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	560	0	0	0	0
Annual Time Burden (Hours)	1,680	1,680	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Forms now display the OMB Control # and current expiration date.

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Annual Cost to Federal Government: $294,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 04/20/2017

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