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 ยท 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 is listed under ICR 202603-0692-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202603-0692-001 | Revision of a currently approved collection | 2026-03-31 | ||
| 202303-0692-002 | Extension without change of a currently approved collection | 2023-03-16 | Approved without change | |
| 202001-0692-001 | Revision of a currently approved collection | 2020-01-30 | Approved with change | |
| 201908-0692-002 | No material or nonsubstantive change to a currently approved collection | 2019-08-27 | Approved without change | |
| 201908-0692-001 | No material or nonsubstantive change to a currently approved collection | 2019-08-05 | Improperly submitted and continue | |
| 201610-0692-001 | Revision of a currently approved collection | 2016-12-02 | Approved without change | |
| 201411-0692-001 | Reinstatement without change of a previously approved collection | 2014-11-14 | Approved without change | |
| 201403-0692-001 | New collection (Request for a new OMB Control Number) | 2014-03-13 | Approved with change |