Information Collection

SSO-012 Request to Reevaluate Special Security Officer's Medical Qualifications

IC 269391 under ICR 202406-1105-004 · OMB 1105-0099.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSO-012 SSO-012 Request to Reevaluate Special Security Officer's Medical Qualifications	Form and Instruction
SSO-012 Request to Reevaluate Special Security Officer's Medical sso012_20240711.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	SSO-012	Request to Reevaluate Special Security Officer's Medical Qualifications	sso012_20240711.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: 27

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	4,293	4,293

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.