TSA Form 2825A LEOSA Identification Card Application

Law Enforcement Officers Safety Act (LEOSA) and Retired Badge/Credential

Documents and Forms

Document Name Document Type
Form TSA Form 2825A TSA Form 2825A LEOSA Identification Card Application Form and Instruction
TSA Form 2825A LEOSA Identification Card Application TSA Form 2825A, LEOSA Identification Card Application.pdf Form and Instruction
TSA Form 2825A LEOSA Identification Card Application TSA Form 2825A, LEOSA Identification Card Application.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	TSA Form 2825A LEOSA Identification Card Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TSA Form 2825A	LEOSA Identification Card Application	TSA Form 2825A, LEOSA Identification Card Application.pdf		Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: DHS/TSA/SORN-002 Transportation Security Threat Assessment System	FR Citation: 79 FR 46862

Number of Respondents: 186	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	186	154	32
Annual IC Time Burden (Hours)	39	36	3
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.