TSA Form 3416 Armed Security Officer Candidate Signature.

DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration

OMB Control Number: 1652-0035
Expiration: 11/30/2022

Clear Form

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; Pub. L.108-176. PRINCIPAL PURPOSES(S): To identify individuals
eligible to serve as armed security officers aboard general aviation flights into DCA. ROUTINE USE(S): This information you provide
may be shared with aircraft and airport operators, and the FAA, or for routine uses identified in TSA system of records, DHS/TSA 002,
Transportation Security Threat Assessment System. DISCLOSURE: Voluntary; failure to furnish the requested information may result in
delays in processing or denial of your nomination.
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 November 30, 2022. Send comments regarding this burden
estimate or collection to: TSA-11, Attention: PRA 1652-0035, 6595 Springfield Center Drive, Springfield, VA 20598-6011.
TSA Form 3416 (10/18) [File: 3400.21]

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