TSA Form 413A Checkpoint Sign-in Log

SENSITIVE SECURITY INFORMATION
This record contains Sensitive Security Information (SSI) when completed
DEPARTMENT OF HOMELAND SECURITY
Transportation Security Administration

OMB control number
1652-0072 Exp. 12/31/2022

Checkpoint Sign-In Log
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:
Full Name

Time

Agency Address

TSA USE

Date

Provided:

Badge

TSA/SIDA Badge #

Agency Name

Second Photo ID

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)

Time

Agency Address

TSA USE

Full Name

Provided:

Badge

TSA/SIDA Badge #

TSA USE

Name of Individual Under Escort
Signature

Badge/Credential #

Second Photo ID

Cell Phone Number

Agency Phone Number

Supervisor/LEO/SIDA Badge #

Name of Individual Under Escort
Signature

Badge

TSA/SIDA Badge #

Airline/Flight#

Carrying:
Firearm
Knife
Electroshock Weapon
Not flying
Airline/Flight#

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.

Carrying:
Firearm
Knife
Electroshock Weapon

Other:

Agency Name

Badge/Credential #

Federal Officer

Not flying
Airline/Flight#

State or Local LEO:
NLETS Flying Armed ID:

Credential

Airline Flying Armed Form

Federal Officer

Completed Required LEO Flying Armed Training?
Yes
No
N/A

Agency Address
Provided:

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.
Other:
Completed Required LEO Flying Armed Training?
Yes
No
N/A

Boarding Pass

Full Name

Time

Federal Officer

State or Local LEO:
NLETS Flying Armed ID:

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)
Date

Agency Phone Number

Agency Name

Credential

Airline Flying Armed Form

Cell Phone Number

Boarding Pass

Supervisor/LEO/SIDA Badge #

Date

Badge/Credential #

State or Local LEO:
NLETS Flying Armed ID:

Credential

Airline Flying Armed Form

Month:

Second Photo ID

Cell Phone Number

Agency Phone Number

Boarding Pass

Supervisor/LEO/SIDA Badge #

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)

Name of Individual Under Escort
Signature

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.

Carrying:
Firearm
Knife
Electroshock Weapon

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 1652-0072, 6595 Springfield Center Drive, Springfield, VA 22150. 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 1652-0072, Law Enforcement Officers (LEOs) Flying Armed, which expires 12/31/2022

TSA Form 413A (3/22) rev. [File: 400.7.5]

Previous editions of this form are obsolete.

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