Information Collection

CSO-012 Request to Reevaluate Court Security Officer's Medical Qualifications

IC 205746 under ICR 202406-1105-004 · OMB 1105-0099.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CSO-012 CSO-012 Request to Reevaluate Court Security Officer's Medical Qualifications	Form and Instruction
CSO-012 Request to Reevaluate Court Security Officer's Medical Q cso012.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

USMS-2013-1-CSO012

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	CSO-012	Request to Reevaluate Court Security Officer's Medical Qualification	cso012.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Justice/USM-010, Judicial Facility Security Index System

FR Citation: 72 FR 33515

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	47,700	47,700

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.