1652-0039 TSAClaimsApp SS

INFORMATION COLLECTION SUPPORTING STATEMENT

TSA Claims Application

OMB control number 1652-0039

Exp. 3/31/2025

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statue and regulation mandating or authorizing the collection of information. (Annotate the CFR parts/sections affected).

The Transportation Security Administration (TSA) adjudicates tort claims under the authority of the Federal Tort Claims Act (FTCA) (28 U.S.C. §§ 1346(b), 1402(b), 2401(b), 2671-2680). To thoroughly examine tort claims against the agency, TSA needs to collect additional information from claimants.

The respondents to this collection are typically the traveling public, but may include others who have contact with TSA operations at various locations. Submission of a claim is entirely voluntary and initiated by individuals. Claimants typically file a claim by submitting to TSA a Standard Form 95 (SF-95), Claim for Damage, Injury, or Death, which is a form prescribed by the Department of Justice and approved under OMB control number 1105-0008. Because TSA requires further clarifying information to thoroughly examine their claim, claimants are asked to complete a Supplemental Information page to accompany the SF-95. For example, the Supplemental Information identifies the airport at which the incident occurred and states, if applicable, whether the incident occurred at a passenger security screening checkpoint or a checked baggage screening location. If the claim involves checked baggage, the Supplemental Information page identifies whether any third parties handled the checked bag and whether a checked bag was delayed. This information enables the claims examiner to promptly initiate a thorough investigation into the alleged loss and significantly reduces the time required to process the claim. This information also assists with identifying whether the claim should be more appropriately processed under the Military Personnel and Civilian Employees’ Claims Act (MPCECA).

Obtaining this information through the Supplemental Information page increases efficiency as it provides relevant information at the beginning of the process rather than creating the need to seek additional information from the claimant later in the claim examination process. For instance, MPCECA, not the FTCA, may cover claims for property damage if the property involved was being used incident to service with the Agency, and the damage or loss was not caused wholly or partly by the negligent or wrongful act or omission of the claimant.

If TSA determines that payment is warranted after review of the submitted information, TSA will send the claimant a form requesting the claimant’s Social Security number or other taxpayer identification number along with their banking information to direct payment to the claimant. TSA seeks to extend the expiration date of these forms, previously approved under OMB control number 1652-0039, for another 3 years.

Claim instructions and forms are available through the TSA website at https://www.tsa.gov. Claimants must download these forms and mail or fax them to TSA.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

On the Supplemental Information page of the TSA Claims Application, claimants are asked to provide additional claim information, including: (1) e-mail address, (2) airport, (3) location of incident within the airport, (4) complete travel itinerary, (5) whether baggage was delayed by the airline, (6) why they believe TSA was negligent, (7) whether they used a third-party baggage service, (8) whether they were traveling under military orders, and (9) whether they submitted claims with the airline or insurance companies. If TSA determines payment is warranted, TSA sends the claimant a form requesting: (1) claimant signature, (2) banking information, and (3) Social Security number (required by the U.S. Treasury for all government payments to the public pursuant to 31 U.S.C. 3325).

TSA uses the data collected from claimants to examine tort claims against the agency to determine alleged TSA liability and to reimburse claimants when claims are approved. In some cases, the information may be used to identify victims of theft or to further the criminal investigations into property theft.

TSA is revising the collection to include TSA Form 600, Authorization for Disclosure of Protected Health Information Pursuant to HIPAA (TSA Form 600). If TSA requires information protected by the Health Insurance Portability and Accountability Act (HIPAA) in order to fully adjudicate a claim, claimants are asked to complete TSA Form 600. TSA also ask claimants to complete TSA Form 600 in order to provide: (1) name, (2) date of birth, (3) Social Security number, (4) address, (5) a description of the information to be disclosed, and (6) signature.

If TSA determines payment is warranted, TSA will send the claimant a form requesting banking information (routing and account numbers) to direct payment to the claimant. The requested information includes: (1) claimant signature, (2) banking information, and (3) Social Security number (required by the U.S. Treasury for all government payments to the public pursuant to 31 U.S.C. 3325).

Claim instructions and forms are available through the TSA website at https://www.tsa.gov. Claimants must download these forms and mail or fax them to TSA. On the Supplemental Information page, claimants are asked to provide additional claim information including: (1) e-mail address, (2) airport, (3) location of incident within the airport, (4) complete travel itinerary, (5) whether baggage was delayed by the airline, (6) why they believe TSA was negligent, (7) whether they used a third-party baggage service, (8) whether they were traveling under military orders, and (9) whether they submitted claims with the airline or insurance companies.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden. [Effective 03/22/01, your response must SPECIFICALLY reference the Government Paperwork Elimination Act (GPEA), which addresses electronic filing and recordkeeping, and what you are doing to adhere to it. You must explain how you will provide a fully electronic reporting option by October 2003, or an explanation of why this is not practicable.]

Currently, TSA only receives claims in writing. In accordance with the FTCA, 28 U.S.C. § 2401(b), a tort claim must be presented in writing to the appropriate Federal agency. Furthermore, pursuant to Department of Justice implementing regulations at 28 CFR 14.2(a), a claim is deemed to have been presented when a Federal agency receives an executed SF-95 or other written notification of an incident accompanied by a claim for money damages in a sum certain from a claimant, a duly authorized agent or legal representative. Due to the requirements for claim to be in writing, TSA is unaware of any Federal agency that accepts tort claim filings electronically.

Once a claim is received by TSA, subsequent information may be submitted via fax or email. This process is consistent with the GPEA’s requirement to allow individuals to submit information or transact with the agency electronically. In addition, the Claims Management System is TSA’s primary tool for recording and processing claims as well as for managing and retrieving claims data. This is consistent with GPEA’s requirement for agencies to maintain records electronically.

Usability Testing Requirement: Pursuant to a new DHS requirement, all Information Collection Requests must undergo usability testing (UX) prior to submission to OMB. See DHS Fiscal Year 2024 Burden Reduction Plan dated, September 22, 2023. TSA conducted the UX with six TSA employees (participants), who had never seen the TSA Form 600 before and were not familiar with the questions on the form. The purpose of the UX was to determine if the TSA Form 600 was easy to use, used plain language for understanding and was a significant burden. Participants found that the form was easy to understand, easy to complete and the instructions were in plain language. In addition, all participants found that the time it took to complete the form was not significant, less than 2.5 minutes, and reflected TSA’s estimated burden of de minimis. There were no recommendations to change the form.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purpose(s) described in Item 2 above.

Tort claims are submitted when an individual believes s/he has experienced property loss or damage, a personal injury, or other damages due to the negligence or wrongful act or omission of a TSA employee, while the TSA employee is acting within the scope of their employment and decides to file a federal tort claim against TSA. The data is not collected from any other source and would not otherwise be collected or available until a claim is filed.

5. If the collection of information has a significant impact on a substantial number of small businesses or other small entities (Item 5 of the Paperwork Reduction Act submission form), describe the methods used to minimize burden.

This collection does not have a significant impact on a substantial number of small businesses.

6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

If the information is not collected, then the claim examiners may be unable to thoroughly examine and adjudicate the claim. As a result, payment may be improperly distributed in response to invalid claims or valid claims may be denied. In addition, 31 U.S.C. § 3325(d) requires that every certified voucher for payment submitted to a disbursing official contain the taxpayer identifying number of each person to whom payment may be made under the voucher. Therefore, failure to provide the taxpayer identifying number may result in the delay or denial of payment.

7. Explain any special circumstances that require the collection to be conducted in a manner inconsistent with the general information collection guidelines in 5 CFR 1320.5(d)(2).

This collection is inconsistent with the requirement in 5 CFR 1320.5(d)(2)(i) because claimants could potentially have more than one claim per quarter based on an alleged loss. As a result, claimants could potentially provide information more frequently than quarterly.

8. Describe efforts to consult persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency's notice, required by 5 CFR 1320.8(d) soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.

As required by 5 CFR 1320.8(d), TSA published a 60-day notice in the Federal Register soliciting comments on this information collection, see 89 FR 78326 (September 25, 2024), and a 30-day notice. See 89 FR 101615 (December 16, 2024). TSA received no comments to the notices.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

TSA may provide payment to claimants if damages arise from the negligence or wrongful act or omission of a TSA employee acting within the scope of employment.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

TSA complies with the confidentiality, protection, and notice provisions of the Privacy Act.

The TSA website and claim form provides the claimant with a Privacy Act Statement, 5 U.S.C. 552a(e)(3), informing the individual of the authority for the collection of the information, the purpose of the collection, whether provision of the information is voluntary, and the routine uses of the information. The Privacy Act limits TSA from divulging any information about the claimant or claim to anyone other than the claimant, unless TSA obtains the claimant’s written permission, or pursuant to another exception to the Privacy Act, such as sharing pursuant to a routine use from the applicable Privacy Act systems of records, DHS/ALL-017 Department of Homeland Security General Legal Records. See 76 FR 72428 (November 23, 2011) and DHS/TSA 013 DHS Claims Records. See 73 FR 63987 (October 28, 2008). The collection is also covered by a Privacy Impact Assessment. See DHS/TSA/PIA-009 Claims Management System (February 5, 2007).

11. Provide additional justification for any questions of sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.

The TSA claim form does not ask any questions of a sensitive nature. However, if the claimant includes, as part of the claim, information of a sensitive nature, such as sexual harassment, allegations of racial profiling, or other similar data, TSA may record the information and forward it to the TSA Office of Civil Rights and Liberties. TSA will maintain any sensitive data that identifies the claimant in accordance with the Privacy Act.

12. Provide estimates of hour burden of the collection of information.

Based on past estimates, TSA estimates that it will receive approximately 7,500 claims on an annual basis. Currently, all claims are submitted in writing by mail. TSA estimates that it will take 30 minutes (0.5 hours) to complete and submit the forms, which results in an estimated burden of 3,750 hours. Additionally, TSA collects payment information from those members of the public whose claims are approved by TSA. TSA estimates that approximately 900 claims are approved each year. TSA estimates it takes 10 minutes (0.1667 hours) to submit payment information for an annual hour burden of 150 hours. TSA estimates that of the 900 claims approved each year, TSA will ask only two claimants per year to complete TSA Form 600. TSA estimates the time to complete TSA Form 600 is 2.5 minutes. As the usage of the form is rare, TSA estimates the burden to be de minimis.

TSA estimates the public average annual hour burden of 3,900 hours (3,750 + 150). To estimate annual hour burden cost, TSA multiples each hour burden by a fully-loaded wage rate¹ of $46.14.² TSA estimates an annual hour burden cost of $173,025 for filing a claim and $6,921 for submitting payment information, for a total annual hour burden cost of this collection of $179,946. Therefore, the total 3-year hour burden cost of this collection is $539,838 ($179,946 x 3).

13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information.

TSA data show that approximately 50 percent of the claims are submitted to TSA through mail. TSA estimates an annual cost burden to respondents of $2,737.50 for postage.³ TSA estimates the total 3-year burden for mailing to be $8,212.50.

14. Provide estimates of annualized cost to the Federal Government. Also, provide a description of the method used to estimate cost, and other expenses that would not have been incurred without this collection of information.

TSA estimates the total cost to the Federal government associated with the claims information collection request to be approximately $283,225 annually. This includes TSA staff costs to maintain and update claims. TSA estimates that four TSA F-band claims staff will spend roughly 32 hours per week on claims adjudication-related duties. TSA calculates a TSA full-time employee (FTE) of 3.19⁴, based on 4 employees multiplied by 32 hours per week, multiplied by 52 weeks and divided the product by 2,087 hours⁵ (standard Federal work year). TSA then multiplied claims staff FTE by the annual salary of a TSA F-Band Employee ($107,927.30).⁶ This results in a total 3-year cost to TSA of $1,032,627, and an annual cost of $344,209.

15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-i.

The respondents to the collection have decreased since the previous OMB approval. As a result, the burden has decreased. TSA adding TSA Form 600 to the collection does not impact the burden as the change to the burden is de minimis.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

TSA will not publish the results of this information collection.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

TSA is not seeking such approval.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB Form 83-I.

TSA is not seeking any exceptions to the certification statement.

1 A fully loaded wage rate accounts for non-wage employee compensation costs incurred by the employer, such as health and retirement benefits, among others.

2 This is the loaded wage rate for members of the general public. BLS. Employer Costs for Employee Compensation – March 2024. Table 1 Employer costs per hour worked for employee compensation and costs as a percent of total compensation: civilian workers. Total compensation, all workers. Last updated June 18,2024. Accessed 9/5/2024. https://www.bls.gov/news.release/archives/ecec_06182024.htm.

3 Cost of a stamp ($0.73) × number of claims mailed (3,750) = $2,737.50. https://store.usps.com/store/results/stamps/_/N-9y93lv?_requestid=464576

4 3.189 = (4 x 32 x 52) / 2,087.

5 OPM changed the 2,080 work hours to 2,087 by amending 5 U.S.C. 5504(b), the latter is assumed to capture year-to-year fluctuations in work hours. Source: Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. 99-272, April 7, 1986).

6 TSA 2024 Pay Rate for E Band Step 5 employee in the National Capital Region.

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