Information Collection

NTIS Limited Access Death Master File Subscriber Certification Form

IC 224474 under ICR 201908-0692-002 · OMB 0692-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0692-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NTIS FM161 NTIS Limited Access Death Master File Subscriber Certification Form	Form
NTIS FM161 NTIS Limited Access Death Master File Subscriber Certifi 0692-0013-NTIS-LADMF-SubscriberCertificationForm-NTIS FM161.pdf	Form

IC Title:

NTIS Limited Access Death Master File Subscriber Certification Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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	NTIS FM161	NTIS Limited Access Death Master File Subscriber Certification Form	0692-0013-NTIS-LADMF-SubscriberCertificationForm-NTIS FM161.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: 560

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	Previously Approved
Annual Number of Responses for this IC	560	560
Annual IC Time Burden (Hours)	1,400	1,400
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.