Transportation Security Officer Medical Questionnaire

ICR 201603-1652-002

OMB: 1652-0032

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2016-05-04
Supplementary Document
2016-05-04
Supplementary Document
2016-05-04
Supplementary Document
2016-05-04
Supplementary Document
2016-05-04
Supporting Statement A
2016-06-23
Supplementary Document
2010-01-22
Supplementary Document
2010-01-22
Supplementary Document
2010-01-15
Supplementary Document
2010-01-15
Supplementary Document
2006-09-15
IC Document Collections
IC ID
Document
Title
Status
191700 Modified
ICR Details
1652-0032 201603-1652-002
Historical Active 201301-1652-006
DHS/TSA
Transportation Security Officer Medical Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 07/01/2016
Retrieve Notice of Action (NOA) 03/31/2016
  Inventory as of this Action Requested Previously Approved
07/31/2019 36 Months From Approved 06/30/2016
29,017 0 26,565
14,071 0 12,912
0 0 0

This collection of information will assist the agency in ensuring that candidates under employment consideration for Transportation Security Officer (TSO) positions meet the qualification standards to successfully perform the functions of the position. The information will be collected from applicants for TSO positions to evaluate a candidate's current and past medical history including visual and aural acuity, physical coordination, and motor skills.

US Code: 49 USC 44935 Name of Law: null
  
None

Not associated with rulemaking

  80 FR 73806 11/25/2015
81 FR 14472 03/17/2016
No

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 Cardiac Further Evaluation ,   Cardiac Surgery Further Evaluation ,   Diabetes Further Evaluation ,   Drug Use Further Evaluation ,   General Medical Further Evaluation ,   Hearing Further Evaluation ,   Hepatitis Further Evaluation ,   Hernia Further Evaluation ,   HIV Further Evaluation ,   Pacemaker Further Evaluation ,   Mental Health Further Evaluation ,   Orthopedic Further Evaluation ,   Palmar Further Evaluation ,   Respiratory Further Evaluation ,   Seizure Further Evaluation ,   Tuberculosis Further Evaluation ,   Vision Further Evaluation ,   Vital Signs Further Evaluation ,   TSO Medical Questionnaire ,   Cancer Further Evaluation

  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 29,017 26,565 0 0 2,452 0
Annual Time Burden (Hours) 14,071 12,912 0 0 1,159 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
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.

$503,074
No
No
No
No
No
Uncollected
Matthew Dorritie 571 227-1524 matthew.dorritie@tsa.dhs.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/31/2016


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