Information Collection

National Technical Information Service (NTIS) Limited Access Death Master File Accredited Conformity Assessment Body Application for Firewalled Status (Firewalled Status Application Form

IC 239096 under ICR 202303-0692-003 · OMB 0692-0015.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NTIS FM101 National Technical Information Service (NTIS) Limited Access Death Master File Accredited Conformity Assessment Body Application for Firewalled Status (Firewalled Status Application Form	Form
NTIS FM101 0692-0015_FM101_LADMF_ACAB Application Form for Firewall 0692-0015_FM101_LADMF_ACAB Application Form for Firewalled Status Form_Fillable.pdf	Form
NTIS FM101 0692-0015_FM101_LADMF_ACAB Application Form for Firewall 0692-0015_FM101_LADMF_ACAB Application Form for Firewalled Status Form_Fillable.pdf	Form

Information Collection (IC) Details

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IC Title:

National Technical Information Service (NTIS) Limited Access Death Master File Accredited Conformity Assessment Body Application for Firewalled Status (Firewalled Status Application Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 FM101	0692-0015_FM101_LADMF_ACAB Application Form for Firewalled Status Form	0692-0015_FM101_LADMF_ACAB Application Form for Firewalled Status Form_Fillable.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 65

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	65	15	50
Annual IC Time Burden (Hours)	65	15	50
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.