Transportation Security Officer Medical Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form TSA Form 1130A-1 TSO Medical Questionnaire	Form and Instruction	Modified	Available
Form TSA Form 1130A-1 TSO Medical Questionnaire and Evaluation; Travel	Form and Instruction	Modified	Repair queued
OPMGOVT-5.pdf	Supplementary Document	Uploaded 2016-05-04	Available
OPMGOVT-10 System.pdf	Supplementary Document	Uploaded 2016-05-04	Repair queued
SORN DHSTSA - 022 71 FR 40530 (7172006).pdf	Supplementary Document	Uploaded 2016-05-04	Repair queued
1652-0032 TranspSOMQ 30DN 88 FR 27524 (5.2.2023).pdf	Supplementary Document	Uploaded 2023-05-02	Repair queued
1652-0032 TranspSOMQ 60DN 88 FR 5903 (1.30.2023).pdf	Supplementary Document	Uploaded 2023-05-01	Repair queued
1652-0032 TranspSOMQ SS 5.2.2023.docx	Supporting Statement A	Uploaded 2023-05-02	Repair queued
privacy_pia_tsa_hraccess[1].pdf	Supplementary Document	Uploaded 2010-01-15	Repair queued
44 USC 44935.doc	Supplementary Document	Uploaded 2006-09-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191700	TSO Medical Questionnaire and Evaluation; Travel	Form and Instruction	Modified	TSO Medical Questionnaire
191700	TSO Medical Questionnaire and Evaluation; Travel	Form and Instruction	Modified

ICR Details

OMB Control No: 1652-0032	ICR Reference No: 202305-1652-001
Status: Historical Active	Previous ICR Reference No: 201904-1652-001
Agency/Subagency: DHS/TSA	Agency Tracking No:
Title: Transportation Security Officer Medical Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/02/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/02/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved	09/30/2023
Responses	22,500	0	22,500
Time Burden (Hours)	37,125	0	37,125
Cost Burden (Dollars)	0	0	0

---

Abstract: This collection of information will assist the agency in ensuring that candidates under employment consideration for Transportation Security Officer (TSO) positions meet the qualification standards to successfully perform the functions of the position. The information will be collected from applicants for TSO positions to evaluate a candidate's current and past medical history including visual and aural acuity, physical coordination, and motor skills.

---

Authorizing Statute(s): US Code: 49 USC 44935
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 5903	01/30/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 27524	05/02/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
TSO Medical Questionnaire and Evaluation; Travel	TSA Form 1130A-1	TSO Medical Questionnaire

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	22,500	22,500	0	0	0	0
Annual Time Burden (Hours)	37,125	37,125	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $3,488,850

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/02/2023

---