Information Collection

Transportation Security Officer Medical Questionnaire

IC 20961 under ICR 201001-1652-001 · OMB 1652-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0032 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Transportation Security Officer Medical Questionnaire	Form and Instruction
Transportation Security Officer Medical Questionnaire SMQ Candidate Version 2.1 (7-24-06).pdf	Form and Instruction

IC Title:

Transportation Security Officer Medical Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

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 and Instruction	N/A	Transportation Security Officer Medical Questionnaire	SMQ Candidate Version 2.1 (7-24-06).pdf		No		Paper Only

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title: OPM/GOVT-10, OPM/GOVT-5

FR Citation: 65 FR 24750

Number of Respondents: 38,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-38,000	38,000
Annual IC Time Burden (Hours)	-12,667	12,667
Annual IC Cost Burden (Dollars)	0	0

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.