Mail or Fax Post-Enrollment Providing of Identity, Citizenship, Immigration Data Docs.

TSA Pre-Check Application Program

TSA PreCheck enrollment screenshots 1-10

Mail or Fax Post-Enrollment Providing of Identity, Citizenship, Immigration Data Docs.

OMB: 1652-0059

Document [pdf]
Download: pdf | pdf
Step 1 of 4 - Applicant Information (Biographic Information)
* Required Fields

Please enter your information below (letters, spaces, hyphens (-), and apostrophes (’) are
allowed in name fields). Then click ‘Next’ to continue or ‘Cancel’ to exit.
Your legal name must match your identification documents.

Legal Name
* First Name

* Middle Name (or NMN if no middle name)

* Last Name

Suffix
-- Choose One -* Gender
-- Choose One -* Date of Birth (MM/DD/YYYY)

* Preferred Language
English
* Method of Contact (At least one method is required)
Email

Verify Email

Country Code

Phone 1

United States(+1)
Country Code

Phone 2

United States(+1)
* Preferred Method of Contact
Email

PRIVACY ACT STATEMENT
Authority: 6 U.S.C. § 1140, 46 U.S.C. § 70105; 49 U.S.C. §§ 106, 114, 5103a, 40103(b)
(3), 40113, 44903, 44935-44936, 44939, and 46105; the Implementing Recommendations
of the 9/11 Commission Act of 2007, § 1520 (121 Stat. 444, Public Law 110-52, August 3,
2007); and Executive Order 9397, as amended.
Purpose: The Department of Homeland Security (DHS) will use your information to
conduct a security threat assessment. Your fingerprints and associated information will be
provided to the Federal Bureau of Investigation (FBI) for the purpose of comparing your
fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or
its successor systems including civil, criminal, and latent fingerprint repositories. The FBI
may retain your fingerprints and associated information in NGI after the completion of this
application and, while retained, your fingerprints may continue to be compared against
other fingerprints submitted to or retained by NGI. DHS will also transmit your fingerprints
for enrollment into Automated Biometrics Identification System (IDENT). If you provide
your Social Security Number (SSN), DHS may provide your name and SSN to the Social
Security Administration (SSA) to compare that information against SSA records to ensure
the validity of the information.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C. 522a(b)
of the Privacy Act, all or a portion of the records or information contained in this system
may be disclosed outside DHS as a routine use pursuant to 5 U.S.C. 522a(b)(3) including
with third parties during the course of a security threat assessment, employment
investigation, or adjudication of a waiver or appeal request to the extent necessary to
obtain information pertinent to the assessment, investigation, or adjudication of your
application or in accordance with the routine uses identified in the TSA system of records
notice (SORN) DHS/TSA 002, Transportation Security Threat Assessment System, or
DHS/TSA 021, TSA Pre

® Application Program for applicants to that program. Records

may be disclosed to contractors and their agents, grantees, experts, consultants, and
others performing or working on a contract, service, grant, cooperative agreement, or
other assignment for DHS, when necessary to accomplish an agency function related to
this system of records. For as long as your fingerprints and associated information are
retained in NGI, your information may be disclosed pursuant to your consent or without
your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as
may be published at any time in the Federal Register, including the Routine Uses for the
NGI system and the FBI’s Blanket Routine Uses.
Disclosure: Furnishing this information (including your SSN) is voluntary; however, if you
do not provide your SSN or any other information requested, DHS may be unable to
complete your application for a security threat assessment.

PAPERWORK REDUCTION ACT STATEMENT:
Statement of Public Burden: This is a voluntary collection of information, but failure to
provide the information may result in an inability to approve your eligibility for the
requested TSA program or benefit. TSA estimates that the total average burden per
response associated with this collection for enrollment is approximately 30 minutes. An
agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid OMB control number. The control
number for this collection is OMB 1652-0059, which expires 11/30/2017.

Step 1 of 4 - Applicant Information (Citizenship)
* Required Fields

Please enter your information below. Then click ‘Next’ to continue or ‘Cancel’ to exit.
Note: At this time, only U.S. citizens, U.S. Nationals and Lawful Permanent Residents (LPR)
are eligible for the application.

* Country of Birth
-- Choose One -* City of Birth

* Country of Citizenship
-- Choose One --

Step 1 of 4 - Applicant Information (Identity)
* Required Fields

Please answer the questions below. Then click ‘Next’ to continue or ‘Cancel’ to exit.
* Have you ever used a maiden/previous name?
* Have you ever used an alias?
* Is your mailing address the same as your residential address?
* Have you lived at your current residential address for more than five (5) years?

Step 1 of 4 - Applicant Information (Attributes)
* Required Fields

US

Metric

* Height
feet

ft

inches

* Weight
pounds
* Hair Color
-- Choose One --

lbs
* Eye Color
-- Choose One --

in

Step 1 of 4 - Applicant Information (Address)
* Required Fields

Please enter your information below. Then click ‘Next’ to continue or ‘Cancel’ to exit.
Mailing Address
* Country
-- Choose One -* Address Line 1

Address Line 2

* City

* Postal Code

Step 2 of 4 - Program Eligibility Questions
* Required Fields

Please answer the questions below. Then click ‘Next’ to continue or ‘Cancel’ to exit.
Note: If you answer 'Yes' to question 2, 3, 4 or 6 you may want to reconsider applying. If
you answer 'Yes' to question 5, because you are currently under indictment or have
open criminal charges, you should consider waiting to apply until these matters are
resolved. Application enrollment fees are not refunded once submitted.

1. * Are you a U.S. citizen, U.S. National or Lawful Permanent Resident (LPR)?
2. * Excluding juvenile cases unless convicted as an adult, have you been convicted, pled
guilty including “no contest” (nolo contendere), or found not guilty by reason of
insanity, of any disqualifying felony listed in TSA Eligibility Requirements, Part A, in any
jurisdiction, military or civilian?
3. * Excluding juvenile cases unless convicted as an adult, have you been convicted, pled
guilty including “no contest” (nolo contendere), or found not guilty by reason of
insanity, of any disqualifying felony listed in TSA Eligibility Requirements, Part B, in any
jurisdiction, military or civilian, during the 7 years before the date of this application?
4. * Have you been released from incarceration in any jurisdiction, military or civilian, for
committing any disqualifying felony listed in TSA Eligibility Requirements, Part B,
during the 5 years before the date of this application?
5. * Are you wanted or under indictment for any disqualifying crime listed in TSA Eligibility
Requirements, Parts A or B?
6. * Have you ever been found by a court or other lawful authority as lacking mental
capacity or involuntarily committed to a mental institution?

Step 3 of 4 - Documents Required for Enrollment
* Required Fields

Please select the required documents to bring to your enrollment. Then click 'Next' to
continue or 'Cancel' to exit.
* Photo ID (Must match the 'enrolling under' name)
-- Choose One -* Do the names (first, middle, last) on your identity documents match (ex. driver’s license
and birth certificate)? For Example:
Answer NO if your driver’s license has your married name and your birth certificate has
your maiden name. In this example, you must provide a marriage certificate that links
the name on the birth certificate to the name on the driver’s license. In some cases,
multiple name change documents are necessary to link identity documents.
Answer YES, if your FIRST and LAST NAMES MATCH on all documents. It is
acceptable if one document includes your full middle name and a second document
includes your middle initial, as long as first and last names match exactly.

Step 4 of 4 - Create an Appointment (Location)
Enter a Postal Code, City, Airport Code or Special Location Access Code to 'Search' for a
location to schedule your appointment.Use the ! to search closest to your physical
location. After selecting a location, click 'Next' to continue or 'Cancel' to exit. Applicants
with appointments will be prioritized. TWIC and HME walk-in applicants will be
prioritized due to employment requirements.

Number of Results

TWIC activations and TWIC card replacement services will be temporarily
unavailable at all Universal enrollment centers from Friday, July 7, 2017, 10:00
PM Eastern through Saturday, July 8, 2017, 11:55 PM Eastern due to necessary
system maintenance. Enrollments for all programs will be unaffected.

Step 4 of 4 - Create an Appointment (Time/Date)
Select a preferred date and time for your appointment at the specified location. Then click
‘Submit’ to confirm or ‘Cancel’ to exit. If you are unable to make an appointment for the
available times or all appointments are booked, click the ‘Back’ button below, (not the
browser’s back button) to select another location. Applicants with appointments will be
prioritized. TWIC and HME walk-in applicants will be prioritized due to employment
requirements.
Appointment Date and Time (first available displayed by default)
* Select Date
Monday, Jul 10th, 2017
* Select Time
10:40 AM
- OR Walk-In

Location Details
Arlington, VA
Location ID: 5044
! 1 Aviation Circle Terminal C
Ronald Reagan Washington National Airport
Arlington, VA 22202
Hours:
Monday - Friday: 07:00 AM - 05:00 PM
Saturday: 09:00 AM - 12:00 PM

Note: This TSA Pre

® Enrollment Center is Pre-Security. No boarding pass is required.

The Enrollment Center is located inside of Ronald Reagan Washington National Airport
(DCA) in Terminal C baggage claim. The location is between baggage claim areas 6 and 7
across from the Information Center.

" Get Email Alerts for this location

TSA PRE

®
!

○ You have successfully completed the online application.
You should receive a confirmation email if you provided an email address.
Pre-Enrolled
Please visit an enrollment center within 120 days to complete your enrollment.
1. Provide required documentation and be fingerprinted.
2. Pay a non-refundable fee with a credit card, money order, company check or
certified/cashier’s check.
Status as of 7/7/2017.
Note: In-person enrollment must be completed within 120 days of pre-enrollment date.

BRING THE FOLLOWING DOCUMENT(S) TO YOUR APPOINTMENT:
1. Passport Book or Card
Legal Name must match exactly on all identification documents brought to enrollment.
Walk-In
Without Scheduling Appointment
Note: Scheduled appointments take priority over walk-ins.

After you have visited an application center and completed the process, you can check
the status of your service at the Universal Enrollment Services (UES) website.
Date:
UE ID:
Service:
Known Traveler Number (KTN):

7/7/2017
UZZY-1XVG86
11115V - Enroll
UNASSIGNED

Known Traveler Numbers (KTNs) are automatically generated and cannot be changed
to accommodate personal preferences.
For information on how to use your KTN, please view the FAQ titled "How do I use my
Known Traveler Number?" available by clicking here. Please note that TSA can
suspend your ability to receive TSA Pre ® expedited screening in the future if you are
found to have committed certain violations of TSA security regulations. Violations
include, but are not limited to, interfering with security operations, access control
violations, providing false or fraudulent documents, making a bomb threat, or bringing
a firearm, explosive, or other prohibited item to an airport or on board an aircraft. The
duration of suspension from participation in TSA Pre ® is related to the seriousness
of the violation and/or a repeated history of regulatory violations.


File Typeapplication/pdf
File Modified2017-07-07
File Created2017-07-07

© 2024 OMB.report | Privacy Policy