TSA Form 3416 Armed Security Officer Candidate Signature.

DEPARTMENT OF HOMELAND SECURITY

OMB Control Number: 1652-0035
Expiration: 07/31/2019

Transportation Security Administration

ARMED SECURITY OFFICER CANDIDATE SIGNATURE
INSTRUCTIONS: To request an Armed Security Officer (ASO) credential, an original copy of the ASO’s signature is needed. The ASO
must print their full name and sign in the middle of the blank space provided in Section II. Per TSA, the signature must be clear of any
markings (such as lines and colors) around it. This form shall be filed and stored in accordance with TSA File Code 3400.21.
SECTION I. CANDIDATE INFORMATION
From [Enter Candidate’s Field Office]:
Date:
ASO Candidate’s Name:
SECTION II. COPY OF SIGNATURE
Print Full Name:
Signature Instructions: Place your handwritten signature in the middle of the blank space below so it can be placed directly on
the credential. If any other markings/lines are found around it, the signature will be rejected.
SIGNATURE:

PRIVACY ACT STATEMENT: AUTHORITY: 49 U.S.C. § 114(f). PRINCIPAL PURPOSE(S): This information will be used to place the candidate’s
original signature on the ASO credential. ROUTINE USE(S): This information may be shared with another federal agency in response to its request, in
connection with the hiring or retention of an employee or the issuance of a security clearance, or for routine uses identified in TSA system of records, DHS/
TSA 002, Transportation Security Threat Assessment System (T-STAS). DISCLOSURE: Voluntary; failure to furnish the requested information may result
in delays in issuing you an ASO credential or an inability to issue you an ASO credential.
PAPERWORK STATEMENT ACT: This is a mandatory collection to participate in the ASO Program. The total average burden per response associated
with this collection is estimated to be approximately 5 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 0MB control number. The control number assigned to this collection is OMB 1652- 0035, which will
expire on July 31, 2019. Send comments regarding this burden estimate or collection to: TSA-11, Attention: PRA 1652-0035, 601 South 12th Street,
Arlington, VA 20598-6011.

TSA Form 3416 (10/18) [File: 3400.21]

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