Information Collection

Online TSO Medical Questionnaire

IC 191700 under ICR 202606-1652-003 · OMB 1652-0032.

Documents and Forms

Document Name Document Type
TSO Medical Questionaire_Online Tool.pdf Other-Screenshots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Online TSO Medical Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			TSO Medical Questionaire_Online Tool.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: DHS TSA 022	FR Citation: 71 FR 40530

Number of Respondents: 18,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18,000	-4,500	22,500
Annual IC Time Burden (Hours)	9,000	-28,125	37,125
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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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