Civil Rights

TSA Customer Comment Card

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.