Information Collection

NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form

IC 225787 under ICR 202401-0692-001 · OMB 0692-0016.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NTIS FM100A NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form	Form and Instruction
NTIS FM100A NTIS Limited Access Death Master File (LADMF) Accredited NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form.pdf	Form and Instruction
NTIS FM100A NTIS Limited Access Death Master File (LADMF) Accredited NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form.pdf	Form and Instruction
NTIS FM100B NTIS Limited Access Death Master File (LADMF) State or L NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems S	Form and Instruction
NTIS FM100B NTIS Limited Access Death Master File (LADMF) State or L NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems S	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	NTIS FM100A	NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form	NTIS Limited Access Death Master File (LADMF) Accredited Conformity Assessment Body Systems Safeguards Attestation Form.pdf		Yes	Yes	Fillable Printable
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 Form	NTIS Limited Access Death Master File (LADMF) State or Local Government Auditor General (AG) or Inspector General (IG) Systems Safeguards Attestation Form.pdf		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 280

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	280	280
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	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.