Limited Access Death Master File (LADMF)
Submit Certification Process Forms
The certification process includes the certification processing fee and form, agreement form, attestation processing fee and form, and firewall processing fee and form (if applicable).
All certification forms will be sent with your certification confirmation invoice number after your payment is processed. If you have not received your forms, please contact [email protected].
All forms (Certification Form, Agreement Form, Attestation Form and Firewall Form) must be submitted together in one email to [email protected] with your invoice number on the Agreement Form. Your confirmation invoice number will be provided to you via email after your payment is processed for submission with your forms. Submit all forms to [email protected]
CERTIFICATION FORM INSTRUCTIONS
- Please check the appropriate boxes in point 2 of the Certification Form and explain how your use of the LADMF is permitted in one or more of the fill-in boxes in 2. If you choose “business purpose”, you must also check and fill in one of the boxes below it.
- Please check the appropriate box in point 4 of the Certification Form and explain how you will ensure the security of the LADMF information if you choose 4B.
- Enter the Invoice/Order Confirmation Number in the appropriate field on the Certification Form. You received your Invoice/Order Confirmation Number by email when you paid the certification processing fee to purchase the Certification Package product DMFCERT0001L.
AGREEMENT FORM INSTRUCTIONS
- Complete the Subscriber Agreement Form if LADMF data will not be shared with other individuals or organizations.
- Complete the Licensee Agreement Form if LADMF data will be shared with other individuals or organizations.
- Review the Subscriber Agreement Form and License Agreement Form for additional details.
ATTESTATION FORM INSTRUCTIONS
- Complete the Subscriber Agreement Form if LADMF data will not be shared with other individuals or organizations.
- Complete the Licensee Agreement Form if LADMF data will be shared with other individuals or organizations.
- Review the Subscriber Agreement Form and License Agreement Form for additional details.