OMB control number

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

OMB 0692-0013 · DOC/NTIS.

OMB 0692-0013

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.

The latest form for NTIS Limited Access Death Master File (LADMF) Certification Form (Derived from the Social Security Administration's Death Master File) expires 2029-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

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

All Historical Document Collections

202603-0692-001	Revision of a currently approved collection	2026-03-31
202303-0692-002 Approved without change	Extension without change of a currently approved collection	2023-03-16
202001-0692-001 Approved with change	Revision of a currently approved collection	2020-01-30
201908-0692-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-08-27
201908-0692-001 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2019-08-05
201610-0692-001 Approved without change	Revision of a currently approved collection	2016-12-02
201411-0692-001 Approved without change	Reinstatement without change of a previously approved collection	2014-11-14
201403-0692-001 Approved with change	New collection (Request for a new OMB Control Number)	2014-03-13