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OMB Control No: 1652-0039	ICR Reference No: 202202-1652-001
Status: Historical Active	Previous ICR Reference No: 201811-1652-002
Agency/Subagency: DHS/TSA	Agency Tracking No: 1652-0039
Title: TSA Claims Application
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: 03/24/2022
	Date Received in OIRA: 02/17/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2025	36 Months From Approved	09/30/2022
Responses	10,250	0	11,400
Time Burden (Hours)	4,708	0	5,300
Cost Burden (Dollars)	2,610	0	2,550

Abstract: The TSA adjudicates tort claims under the authority of the Federal Tort Claims Act (FTCA) (28 U.S.C. §§ 1346(b), 1402(b), 2401(b), 2671-2680). To thoroughly examine tort claims against the agency, TSA needs to collect additional information from claimants. The respondents to this collection are typically the traveling public, but may include others who have contact with TSA operations at various locations. Submission of a claim is entirely voluntary and initiated by individuals. Claimants typically file a claim by submitting to TSA a Standard Form 95 (SF-95), Claim for Damage, Injury, or Death, a form prescribed by the Department of Justice and approved under OMB control number 1105-0008. Because TSA requires further clarifying information in order to thoroughly examine their claim, claimants are asked to complete a Supplemental Information page added to the SF-95. For example, the Supplemental Information identifies the airport at which the incident occurred and states, if applicable, whether the incident occurred at a passenger security screening checkpoint or a checked baggage screening location. If the claim involves checked baggage, the Supplemental Information page identifies whether any third parties handled the checked bag and whether a checked bag was delayed. This information enables the claims examiner to promptly initiate a thorough investigation into the alleged loss and significantly reduces the time required to process the claim. This information also assists with identifying whether the claim should be more appropriately processed under the Military Personnel and Civilian Employees’ Claims Act (MPCECA).

Authorizing Statute(s): US Code: 28 USC 1346(b), 1402(b), 2401(b), Name of Law: Federal Tort Claims Act

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:
	86 FR 62563	11/10/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 6889	02/07/2022
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Filing a Claim	SF 95
Submitting Payment Information

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	10,250	11,400	-1,150
Annual Time Burden (Hours)	4,708	5,300	-592
Annual Cost Burden (Dollars)	2,610	2,550	60

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 has been no change to this collection of information since previous OMB approval. However, the respondents and hour burden have decreased.

Annual Cost to Federal Government: $191,579

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Christina Walsh 571 227-2062 christina.walsh@tsa.dhs.gov

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