TSA Form 2825A LEOSA Identification Card Application

Law Enforcement Officers Safety Act (LEOSA) and Retired Badge/Credential

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0071 can be found here:

Documents and Forms

Document Name Document Type
Form TSA Form 2825A TSA Form 2825A LEOSA Identification Card Application Form and Instruction
TSA Form 2825A LEOSA Identification Card Application TSA-FORM2825AFINALv170717.pdf ishare.tsa.dhs.gov/PoliciesAndForms/forms/Forms%20Library/TSA-FORM2825AFINALv170717.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	TSA Form 2825A LEOSA Identification Card Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TSA Form 2825A	LEOSA Identification Card Application	TSA-FORM2825AFINALv170717.pdf	https://ishare.tsa.dhs.gov/PoliciesAndForms/forms/Forms%20Library/TSA-FORM2825AFINALv170717.pdf	Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: DHS/TSA/SORN-002 Transportation Security Threat Assessment System	FR Citation: 79 FR 46862

Number of Respondents: 32	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	3	3
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.