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

Forms and Documents

Document Name	Status
Form NTIS FM161 NTIS Limited Access Death Master File Subscriber Certification Form Form	Modified
Updated 0692-0013-NTIS-LADMF-CertificationForm-SS-Rev 03 24 20.docx Supporting Statement A	2020-03-25

IC Document Collections

IC ID	Document Title	Status
224474	NTIS Limited Access Death Master File Subscriber Certification Form Form	Modified

ICR Details

OMB Control No: 0692-0013	ICR Reference No: 202001-0692-001
Status: Active	Previous ICR Reference No: 201908-0692-002
Agency/Subagency: DOC/NTIS	Agency Tracking No: ML
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
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/25/2020
	Date Received in OIRA: 01/30/2020
Terms of Clearance: This collection is approved based on the revised materials provided by the Department.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	36 Months From Approved	03/31/2020
Responses	250	0	560
Time Burden (Hours)	625	0	1,400
Cost Burden (Dollars)	0	0	0

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Abstract: To collect information necessary to support the certification process required by Section 203 of the Bipartisan Budget Act of 2013 (Pub. L. 113-67) for members of the public to be given access to the Death Master File containing information about deceased persons during the three-calendar-year period after that person's death.

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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:
	84 FR 64872	11/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 5202	01/29/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
NTIS Limited Access Death Master File Subscriber Certification Form	NTIS FM161	Limited Access Death Master File Certification Form

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ICR Summary of Burden

	Total Approved	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	250	560	0	-310	0	0
Annual Time Burden (Hours)	625	1,400	0	-775	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Since NTIS estimates that 250 respondents each year will submit the form, the total annual cost to the public will be $795,000 ($732,500 in fees + $62,500 in staff time = $795,000).

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Annual Cost to Federal Government: $62,500

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? Uncollected

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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: 01/30/2020

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