NTIS Limited Access Death Master File (LADMF) 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 Form 100B Systems Safeguards Attetations for State and Local AGs and IGS	Form	Modified	Available
Form Form 100A Safeguards Attestation Froms	Form	Modified	Available
Form FM 161 LADMF Certification Form	Form	Modified	Available
Form FM 101 Application Form for Firewalled Status	Form	Modified	Available
0692-0013-NTIS-LADMF Collection-SupportingStatement_Final Draft 03 2026.docx	Supporting Statement A	Uploaded 2026-03-31	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	Modified	Systems Safeguards Attetations for State and Local AGs and IGS
224474	NTIS Limited Access Death Master File Subscriber Certification Form	Form	Modified	Safeguards Attestation Froms
224474	NTIS Limited Access Death Master File Subscriber Certification Form	Form	Modified	LADMF Certification Form
224474	NTIS Limited Access Death Master File Subscriber Certification Form	Form	Modified	Application Form for Firewalled Status
224474	NTIS Limited Access Death Master File Subscriber Certification Form	Form	Modified

ICR Details

OMB Control No: 0692-0013	ICR Reference No: 202603-0692-001
Status: Received in OIRA	Previous ICR Reference No: 202303-0692-002
Agency/Subagency: DOC/NTIS	Agency Tracking No:
Title: NTIS Limited Access Death Master File (LADMF) Certification Form (Derived from the Social Security Administration's Death Master File)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/31/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2026
Responses	260	260
Time Burden (Hours)	780	780
Cost Burden (Dollars)	0	0

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Abstract: This is an extension of a currently approved information collection, The National Technical Information Service (NTIS) Limited Access Death Master File Certification Form, Form NTIS FM161 (Certification Form), is 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 the death of an individual unless the person requesting the information has been certified under a program established by the Secretary of Commerce.

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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:
	91 FR 4064	01/30/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 14827	03/27/2026
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 Subscriber Certification Form	Form 100A, FM 101, FM 161, Form 100B	Application Form for Firewalled Status ,   LADMF Certification Form ,   Safeguards Attestation Froms ,   Systems Safeguards Attetations for State and Local AGs and IGS

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	260	260	0	0	0	0
Annual Time Burden (Hours)	780	780	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:

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Annual Cost to Federal Government: $126,360

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? No

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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: 03/31/2026

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