Information Collection

Civil Rights

IC 210316 under ICR 201608-1652-001 · OMB 1652-0030.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0030 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Complaint Form (Version to OMB) (3).docx TBD New Form	Other-On-Line Form
MB Complaint Process for Travelers.doc www.tsa.gov/traveler-information/claims-management-branch	Other-On-Line

IC Title:

Civil Rights

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

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
Other-On-Line Form			Complaint Form (Version to OMB) (3).docx	TBD New Form	Yes	Yes	Fillable Printable
Other-On-Line			MB Complaint Process for Travelers.doc	http://www.tsa.gov/traveler-information/claims-management-branch	Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

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	Previously Approved
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	375	375
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.