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: 201301-1652-006
Status: Historical Active	Previous ICR Reference No: 201001-1652-001
Agency/Subagency: DHS/TSA	Agency Tracking No:
Title: Transportation Security Officer Medical Questionnaire
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/29/2013
	Date Received in OIRA: 01/29/2013
Terms of Clearance: Upon resubmission, TSA should include a plan for electronic submission of information. In addition, TSA should provide an estimate of the additional costs to respondents for follow-up and compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	26,565	0	0
Time Burden (Hours)	12,912	0	0
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 1130A-1, TSA Form 1130B-2, TSA Form 1130B-1, TSA Form 1130B-6, TSA Form 1130B-3, TSA Form 1130B-4, TSA Form 1130B-5, TSA Form 1130B-7, TSA Form 1130B-8, TSA Form 1130B-9, TSA Form 1130B-10, TSA Form 1130B-11, TSA Form 1130B-12, TSA Form 1130B-13, TSA Form 1130B-14, TSA Form 1130B-15, TSA Form 1130B-16, TSA Form 1130B-19, TSA Form 1130B-17, TSA Form 1130B-18	, , , , , , , , , , , , , , , , , , ,

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