View Information Collection Request (ICR) Package
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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:
201001-1652-001
Status:
Historical Active
Previous ICR Reference No:
200608-1652-003
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:
03/16/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/22/2010
Terms of Clearance:
Approved for 2 years with this ToC: This collection is approved for only two years due to lack of full GPEA compliance.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2012
36 Months From Approved
03/31/2010
Responses
26,565
0
68,438
Time Burden (Hours)
12,912
0
22,813
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:
74 FR 55060
10/26/2009
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 2556
01/15/2010
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
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
TSO Medical Questionnaire and Evaluation
TSA Form 1130B-3, TSA Form 1130B-4, TSA Form 1130B-18, TSA Form 1130B-5, TSA Form 1130B-6, TSA Form 1130B-7, TSA Form 1130A-1, TSA Form 1130B-1, TSA Form 1130B-14, TSA Form 1130B-2, TSA Form 1130B-8, TSA Form 1130B-9, TSA Form 1130B-10, TSA Form 1130B-15, TSA Form 1130B-19, TSA Form 1130B-11, TSA Form 1130B-12, TSA Form 1130B-13, TSA Form 1130B-16, TSA Form 1130B-17
TSO Medical Questionnaire
,
Cancer Further Evaluation
,
Cardiac Further Evaluation
,
Cardiac Surgery Further Evaluation
,
Diabetes Further Evaluation
,
Drug Use Further Evaluation
,
General Medical Further Evaluation
,
Hearing Further Evaluation
,
Hepatitis Further Evaluation
,
Hernia Further Evaluation
,
HIV Further Evaluation
,
Pacemaker Further Evaluation
,
Mental Health Further Evaluation
,
Orhopedic
,
Palmar Further Evaluation
,
Respiratory Further Evaluation
,
Seizure Further Evaluation
,
TB Further Evaluation
,
Vision Further Evaluation
,
Vital Signs 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
26,565
68,438
0
-41,873
0
0
Annual Time Burden (Hours)
12,912
22,813
0
-9,901
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The burden has decreased based on the number of respondents. The number of TSO hiring has decreased.
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)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Joanna Johnson 571 227-3651 joanna.johnson@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:
01/22/2010
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