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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.