Submitting Payment Information

TSA Claims Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0039 can be found here:

Documents and Forms

Document Name Document Type
0-0-1 Approval_rtf - 3-21-18.rtf Other-Letter
0-0-2 Settlement_updated rtf - 3-21-18.rtf Other-Letter

Information Collection (IC) Details

IC Title:	Submitting Payment Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-Letter			0-0-1 Approval_rtf - 3-21-18.rtf		Yes	Yes	Fillable Printable
Other-Letter			0-0-2 Settlement_updated rtf - 3-21-18.rtf		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: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	200	200
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.