View Information Collection Request (ICR) Package

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: 201203-1652-001
Status: Historical Inactive	Previous ICR Reference No: 201001-1652-001
Agency/Subagency: DHS/TSA	Agency Tracking No:
Title: Transportation Security Officer Medical Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 08/08/2012
	Date Received in OIRA: 03/30/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2012	36 Months From Approved	08/31/2012
Responses	26,565	0	26,565
Time Burden (Hours)	12,912	0	12,912
Cost Burden (Dollars)	0	0	0

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

IC Title	Form No.	Form Name
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	, , , , , , , , , , , , , , , , , , ,

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