Information Collection

Applicants' Time Waiting as Healthcare Provider Completes Forms

IC 259987 under ICR 202305-1652-002 · OMB 1652-0043.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TSA Form 1163 Applicants' Time Waiting as Healthcare Provider Completes Forms	Form and Instruction
Form TSA Form 1163 Treating Physician Status Report Applicants' Time Waiting as Healthcare Provider Completes Forms	Form and Instruction
Form TSA Form 1133-3 Practical Exercise Performance Requirements Applicants' Time Waiting as Healthcare Provider Completes Forms	Form and Instruction
TSA Form 1163 Treating Physician Status Report TSA Form 1163, Treating Physician Status Report.pdf	Form and Instruction
TSA Form 1163 Treating Physician Status Report TSA Form 1163, Treating Physician Status Report.pdf	Form and Instruction
TSA Form 1133-3 Practical Exercise Performance Requirements TSA Form 1133-3, Practical Exercise Performance Requirements.pdf	Form and Instruction
TSA Form 1133-3 Practical Exercise Performance Requirements TSA Form 1133-3, Practical Exercise Performance Requirements.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TSA Form 1163				Yes	Yes	Fillable Fileable Signable
Form and Instruction	TSA Form 1133-3				Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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