NTIS Limited Access Death Master File (LADMF) Subscriber Certification Form (Derived from the Social Security Administration's Death Master File)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NTIS FM161 NTIS Limited Access Death Master File Subscriber Certification Form	Form	Unchanged	Available
2019 Fillable dmf-certification form revised 080219 with track changes.docx	Supplementary Document	Uploaded 2019-08-27	Available
Justification of Nonsubstantive Change Request for LADMF 0692-0013.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-08-27	Available
0692-0013-NTIS-LADMF-Subscriber-CertificationForm-SupportingStatement-12-7-2016.doc	Supporting Statement A	Uploaded 2016-12-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224474	NTIS Limited Access Death Master File Subscriber Certification Form	Form	Unchanged	NTIS Limited Access Death Master File Subscriber Certification Form

ICR Details

OMB Control No: 0692-0013	ICR Reference No: 201908-0692-002
Status: Historical Active	Previous ICR Reference No: 201610-0692-001
Agency/Subagency: DOC/NTIS	Agency Tracking No: ML
Title: NTIS Limited Access Death Master File (LADMF) Subscriber Certification Form (Derived from the Social Security Administration's Death Master File)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/27/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/27/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	01/31/2020	01/31/2020
Responses	560	0	560
Time Burden (Hours)	1,400	0	1,400
Cost Burden (Dollars)	0	0	0

---

Abstract: To collect information necessary to support the certification process required by Section 203 of the Bipartisan Budget Act of 2013 (Pub. L. 113-67) for members of the public to be given access to the Death Master File containing information about deceased persons during the three-calendar-year period after that person's death.

---

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

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 66256	09/27/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 84559	11/23/2016
Did the Agency receive public comments on this ICR? No

---

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 Subscriber Certification Form	NTIS FM161	NTIS Limited Access Death Master File Subscriber Certification Form

---

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)	1,400	1,400	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: Changes were made to bring the form into compliance as a result of the proposed rule.

---

Annual Cost to Federal Government: $882,000

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

---

Common Form ICR:  No

---

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: 08/27/2019

---