Information Collection

TSA Claims Management System

IC 43964 under ICR 200904-1652-002 · OMB 1652-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0039 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SF 95 TSA Claims Management System	Form
SF 95 Claim for Damage Injury or Death sf-95_claim_package.pdf www.tsa.gov	Form
File 600.9.2 ATTACHMENT TO FTCA CLAIM APPROVAL LETTER FTCA Sttlmnt attchmnt.pdf	Form

IC Title:

TSA Claims Management System

Agency IC Tracking Number:

1652-0039

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5(d)(2)(i)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 95	Claim for Damage Injury or Death	sf-95_claim_package.pdf	www.tsa.gov	Yes	No	Printable Only
Form	File 600.9.2	ATTACHMENT TO FTCA CLAIM APPROVAL LETTER	FTCA Sttlmnt attchmnt.pdf		No		Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	22,800	0	-1,200	24,000
Annual IC Time Burden (Hours)	11,400	11,400	-6,400	6,400
Annual IC Cost Burden (Dollars)	8,900	-8,883,100	-468,000	9,360,000

Documents for IC

table that charts IC Documents
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.