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: 201603-1652-002
Status: Historical Active	Previous ICR Reference No: 201301-1652-006
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: Approved without change	Conclusion Date: 07/01/2016
	Date Received in OIRA: 03/31/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2019	36 Months From Approved	06/30/2016
Responses	29,017	0	26,565
Time Burden (Hours)	14,071	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-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-17, TSA Form 1130B-18, TSA Form 1130B-19, TSA Form 1130A-1, TSA Form 1130B-2, TSA Form 1130B-1, TSA Form 1130B-3, TSA Form 1130B-4, TSA Form 1130B-5, TSA Form 1130B-6, TSA Form 1130B-7, TSA Form 1130B-8, TSA Form 1130B-9	, , , , , , , , , , , , , , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	29,017	26,565	2,452
Annual Time Burden (Hours)	14,071	12,912	1,159
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes to the information being collected. However, the burden has increased due to the use of better estimates provided by the program office. Due to improved efficiencies in the program office, the cost to TSA has decreased. For example, either the provider or the candidate will ship the FE forms when shipping packages, but not both. Therefore, the cost is per candidate delivery to the contractor, as both the candidate and the provider will complete and review the same form for shipment instead of separately as done in the past.

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