TSO Medical Questionnaire and Evaluation

Transportation Security Officer Medical Questionnaire

OMB: 1652-0032

IC ID: 191700

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

TSO Medical Questionnaire and Evaluation
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction TSA Form 1130B-2 Cardiac Further Evaluation CARDIAC - TSA_Form_1130B-2_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-3 Cardiac Surgery Further Evaluation CARDIAC SURGERY- TSA_Form_1130B-3_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-4 Diabetes Further Evaluation DIABETES - TSA_ Form_1130B-4_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-5 Drug Use Further Evaluation DRUG USE - TSA_Form_1130B-5_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-6 General Medical Further Evaluation GENERAL MED - TSA_Form_1130B-6_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-7 Hearing Further Evaluation HEARING - TSA_Form_1130B-7_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-8 Hepatitis Further Evaluation HEPATITIS - TSA_Form_1130B-8_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-9 Hernia Further Evaluation HERNIA - TSA_Form_1130B-9_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-10 HIV Further Evaluation HIV - TSA_Form_1130B-10_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-11 Pacemaker Further Evaluation PACEMAKER - TSA_Form_1130B-11_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-12 Mental Health Further Evaluation MENTAL HEALTH - TSA_Form_1130B-12_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-13 Orthopedic Further Evaluation ORTHOPEDIC - TSA_Form_1130B-13_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-14 Palmar Further Evaluation PALMAR - TSA_Form_1130B-14_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-15 Respiratory Further Evaluation RESPIRATORY - TSA_Form_1130B-15_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-16 Seizure Further Evaluation SEIZURE - TSA_Form_1130B-16_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-17 Tuberculosis Further Evaluation TB - TSA_Form_1130B-17_ FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-18 Vision Further Evaluation VISION - TSA_Form_1130B-18_FINAL_01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130B-19 Vital Signs Further Evaluation VITAL SIGNS - TSA_Form_1130B-19_FINAL_ 01 08 10.docx No   Paper Only
Form and Instruction TSA Form 1130A-1 TSO Medical Questionnaire TSA_Form_1130A-1_FINAL_03_31_2016.pdf No   Paper Only
Form and Instruction TSA Form 1130B-1 Cancer Further Evaluation CANCER - TSA_Form_1130B-1_FINAL_01 08 10.docx No   Paper Only

Homeland Security Border and Transportation Security

 

29,017 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 29,017 0 0 2,452 0 26,565
Annual IC Time Burden (Hours) 14,071 0 0 1,159 0 12,912
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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