CSO-012 Request to Reevaluate Court Security Officer's Medical Qualifications

USMS Medical Forms

Documents and Forms

Document Name Document Type
Form CSO-012 CSO-012 Request to Reevaluate Court Security Officer's Medical Qualifications Form and Instruction
CSO-012 Request to Reevaluate Court Security Officer's Medical Q cso012.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CSO-012 Request to Reevaluate Court Security Officer's Medical Qualifications	Agency IC Tracking Number:	USMS-2013-1-CSO012

Is this a Common Form? No		IC Status: Unchanged

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
Form and Instruction	CSO-012	Request to Reevaluate Court Security Officer's Medical Qualifications	cso012.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Justice/USM-010, Judicial Facility Security Index System	FR Citation: 72 FR 33515

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	47,700	47,700

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.