Information Collection

Crew Member Class Roster and Injury Waiver Form

IC 20954 under ICR 201804-1652-001 · OMB 1652-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0028 can be found here:

Documents and Forms

Document Name Document Type
Form TSA Form 1915 Crew Member Class Roster and Injury Waiver Form Form
TSA Form 1915 CMSDT Program Attendance Roster TSA-Form1915FINALv180308.pdf www.tsa.gov/webform/crew-member-self-defense-registration-request Form
TSA Form 1915A CMSDT LIMITED ASSUMPTION OF RISK AND WAIVER OF RESPONSIB TSA-Form1915AFINALv180316.pdf www.tsa.gov/for-industry/training Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Crew Member Class Roster and Injury Waiver Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form	TSA Form 1915	CMSDT Program Attendance Roster	TSA-Form1915FINALv180308.pdf	https://www.tsa.gov/webform/crew-member-self-defense-registration-request	Yes	Yes	Fillable Fileable Signable
Form and Instruction	TSA Form 1915A	CMSDT LIMITED ASSUMPTION OF RISK AND WAIVER OF RESPONSIBILITY	TSA-Form1915AFINALv180316.pdf	https://www.tsa.gov/for-industry/training	Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: DHS General Training Records	FR Citation: 73 FR 71656

Number of Respondents: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,700	700	1,000
Annual IC Time Burden (Hours)	28	-55	83
Annual IC Cost Burden (Dollars)	0	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.