Office of Law Enforcement/Federal Air Marshal Service (OLE/FAMS) Mental Health Certification

Forms and Documents

Document Name	Status
Form TSA 1164 FAMS Mental Health Certification Form	Modified
1652-0043 OLEFAM MHC 30DN (81 FR 944_182016).pdf Supplementary Document	2016-01-13
1652-0043 OLEFAM MHC 60DN (80 FR 65237_10262015).pdf Supplementary Document	2016-01-13
1652-0043 OLE FAM MHC SS 01282016.doc Supporting Statement A	2016-01-28
DHS-TSA 001.pdf Supplementary Document	2010-09-24
OPM-GOVT-10%20-%20Medical%20Records[1].pdf Supplementary Document	2010-09-24
49 USC 44917[1].doc Supplementary Document	2007-08-29
49 USC 44903[1].doc Supplementary Document	2007-08-29
49 USC 44901[1].doc Supplementary Document	2007-08-29

IC Document Collections

IC ID	Document Title	Status
46519	FAMS Mental Health Certification Form	Modified

ICR Details

OMB Control No: 1652-0043	ICR Reference No: 201601-1652-004
Status: Historical Active	Previous ICR Reference No: 201210-1652-002
Agency/Subagency: DHS/TSA	Agency Tracking No:
Title: Office of Law Enforcement/Federal Air Marshal Service (OLE/FAMS) Mental Health Certification
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: 03/01/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2019	36 Months From Approved	06/30/2016
Responses	600	0	600
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	270

---

Abstract: In furtherance of TSA's authority to provide for deployment of Federal Air Marshals (FAMs) on passenger flights, and provide for appropriate training, supervision, and equipment of FAMs TSA policy requires that applicants for Office of Law Enforcement/ Federal Air Marshal positions meet certain medical standards, which includes a psychological evaluation. Applicants will be required to complete a certification regarding their mental health history and provide an explanation for anything they cannot certify. This certification is carefully geared to capitalize on other elements of the assessment process, such as personal interviews, physical task assessment, background investigation, as well as the other components of the medical examination and assessment.

---

Authorizing Statute(s): US Code: 49 USC 44901 Name of Law: ATSA
   US Code: 49 USC 44903 Name of Law: ATSA
   US Code: 49 USC 44917 Name of Law: ATSA
  

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:
	80 FR 65237	10/26/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 944	01/08/2016
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
FAMS Mental Health Certification	TSA 1164	Mental Health Certification

---

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	600	600	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	0	0
Annual Cost Burden (Dollars)	0	270	0	0	-270	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:

---

Annual Cost to Federal Government: $3,175

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]? 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? Uncollected

---

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: 03/01/2016

---