Information Collection

Treating Physician Status Report

IC 236329 under ICR 201906-1652-001 · OMB 1652-0043.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0043 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TSA Form 1163 Treating Physician Status Report	Form and Instruction
TSA Form 1163 Treating Physician Status Report TSA Form 1163, Treating Physician Status Report 6.26.2019.docx	Form and Instruction

IC Title:

Treating Physician Status Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	TSA Form 1163	Treating Physician Status Report	TSA Form 1163, Treating Physician Status Report 6.26.2019.docx		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: Employee Medical File of Records of TSO

FR Citation: 71 FR 35360

Number of Respondents: 600

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
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	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.