View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1652-0032
ICR Reference No:
200608-1652-003
Status:
Historical Active
Previous ICR Reference No:
200503-1652-001
Agency/Subagency:
DHS/TSA
Agency Tracking No:
Title:
Transportation Security Officer Medical Questionnaire
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/04/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/25/2006
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2010
36 Months From Approved
09/30/2008
Responses
68,438
0
38,100
Time Burden (Hours)
22,813
0
11,430
Cost Burden (Dollars)
0
0
0
Abstract:
This collection of information will assist the agency in ensuring that candidates under employment consideration for Transportation Security Officer (TSO) positions meet the qualification standards to successfully perform the functions of the position. The information will be collected from applicants for TSO positions to evaluate a candidate's candidates current and past medical history including visual and aural acuity, physical coordination, and motor skills.
Authorizing Statute(s):
US Code:
49 USC 44935
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
71 FR 20118
04/19/2006
30-day Notice:
Federal Register Citation:
Citation Date:
71 FR 50080
08/24/2006
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
20
IC Title
Form No.
Form Name
Cancer FE form
n/a
Further Evaluation Form Cancer
Cardiac FE form
n/a
Cardiac Further Evaluation form
Cardiac Surgery FE form
n/a
Cardiac Surgery further evaluation
Diabetes FE form
n/a
Diabetes Further Evaluation
Drug Alcohol Use FE form
n/a
Drug Alcohol Use Further Evaluation
General FE form
n/a
General Further Evaluation
HIV FE form
n/a
HIV further evaluation
Hearing FE form
n/a
Hearing Further Evaluation
Hepatitus FE form
n/a
Hepatitus Further Evaluation
Hernia FE form
n/a
Hernia further evaluation
Implanted Medical Device FE form
n/a
Implanted Medical Device further evaluation
Mental Health FE form
n/a
Mental Health further evaluation
Orthopedic FE form
n/a
Orthopedic further evaluation
Palmar Sensation FE form
n/a
Palmar Sensation further evaluation
Respiratory FE form
n/a
Respiratory further evaluation
Seizure FE form
n/a
Seizure further evaluation
TB FE form
n/a
TB further evaluation
Transportation Security Officer Medical Questionnaire
N/A
Transportation Security Officer Medical Questionnaire
Vision FE form
n/a
Vision further evaluation
Vital Signs FE form
n/a
Vital Signs further evaluation
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
68,438
38,100
0
30,338
0
0
Annual Time Burden (Hours)
22,813
11,430
0
11,383
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
See supporting statement. TSA added additional medical evaluation forms, which increased the respondent population and number of responses. However, we note that the hour burden reflected in chart above is not accurate; it should be 19,013, NOT 22,813. The way we are required to enter ICs divides burden up equally for all of the further evaluation forms and that is not the method we used for our calculations. This is because not all respondents need to fill out all further evaluation forms; depending on the medical conditions of applicants, some respondents may fill out 1 or 5 or none and we have no concrete way to determine the exact numbers. Thus, our supporting statement reflects our best good faith estimate.
Annual Cost to Federal Government:
$2,556,241
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Katrina Wawer 571 227-1995 katrina.wawer@dhs.gov
Common Form ICR:
No
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:
09/25/2006
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