Form TSA Form 413A TSA Form 413A Checkpoint Sign-in Log

OMB number 1652-NEW

Exp. xx/xx/xxxx

SENSITIVE SECURITY INFORMATION

This record will contain Sensitive Security Information (SSI) when completed

INSTRUCTIONS: Those individuals authorized specialized screening in Chapter 1 of the Specialized Screening SOP must complete all applicable fields before entering a U.S. airport sterile area. An airport assigned LEO, TSA STSO, or designated TSA Representative may fill in the information; however, the individual authorized specialized screening must sign in the appropriate block. For questions or to provide feedback, please email [email protected].

Airport:

Checkpoint:

Month:

Date		Full Name		Agency Name		Badge/Credential #	Federal Officer	Airline/Flight#
Time		Agency Address					State or Local LEO: NLETS Flying Armed ID: I am authorized to fly armed on official agency business. I have an operational need to have my weapon accessible during this flight, in accordance with Title 49, C.F.R Part 1544.
TSA USE	Provided: Badge Credential Second Photo ID Airline Flying Armed Form Boarding Pass			Cell Phone Number	Agency Phone Number			Carrying: Firearm Knife (CBP only) Electroshock Weapon
	TSA/SIDA Badge #		Supervisor/LEO/SIDA Badge #	Name of Individual Under Escort
I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (See 18 U.S.C. 1001)				Signature			Other:
							Completed Required LEO Flying Armed Training? Yes No N/A	Not flying
Date		Full Name		Agency Name		Badge/Credential #	Federal Officer	Airline/Flight#
Time		Agency Address					State or Local LEO: NLETS Flying Armed ID: I am authorized to fly armed on official agency business. I have an operational need to have my weapon accessible during this flight, in accordance with Title 49, C.F.R Part 1544.
TSA USE	Provided: Badge Credential Second Photo ID Airline Flying Armed Form Boarding Pass			Cell Phone Number	Agency Phone Number			Carrying: Firearm Knife (CBP only) Electroshock Weapon
	TSA/SIDA Badge #		Supervisor/LEO/SIDA Badge #	Name of Individual Under Escort
I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (See 18 U.S.C. 1001)				Signature			Other:
							Completed Required LEO Flying Armed Training? Yes No N/A	Not flying
Date		Full Name		Agency Name		Badge/Credential #	Federal Officer	Airline/Flight#
Time		Agency Address					State or Local LEO: NLETS Flying Armed ID: I am authorized to fly armed on official agency business. I have an operational need to have my weapon accessible during this flight, in accordance with Title 49, C.F.R Part 1544.
TSA USE	Provided: Badge Credential Second Photo ID Airline Flying Armed Form Boarding Pass			Cell Phone Number	Agency Phone Number			Carrying: Firearm Knife (CBP only) Electroshock Weapon
	TSA/SIDA Badge #		Supervisor/LEO/SIDA Badge #	Name of Individual Under Escort
I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (See 18 U.S.C. 1001)				Signature			Other:
							Completed Required LEO Flying Armed Training? Yes No N/A	Not flying

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a “need to know”, as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administrator or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. Government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

PAPERWORK REDUCTION ACT STATEMENT: TSA is collecting this information to perform specialized screening for LEOs flying armed. The public burden for collecting this information is estimated to be approximately 1 minute. Send comments regarding this burden estimate or collection to: TSA-11, Attention: PRA 1652-NEW, 601 South 12th Street, Arlington, VA 20598. This is a mandatory collection of information. An agency may not conduct or sponsor, and persons are not required to respond to a collection of information, unless it displays a valid OMB control number. The OMB control number assigned to this collection is 1652-NEW, Law Enforcement Officers (LEOs) Flying Armed, which expires xx/xx/20xx.

TSA Form 413A (4/18) rev. [File: 400.7.5] Previous editions of this form are obsolete . Page of