Information Collection

TSO Medical Questionnaire

IC 280827 under ICR 202606-1652-003 · OMB 1652-0032.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TSA Form 1137-1 TRANSPORTATION SECURITY OFFICER MEDICAL CLEARANCE TSO Medical Questionnaire	Form and Instruction
TSA Form 1137-1 TRANSPORTATION SECURITY OFFICER MEDICAL CLEARANCE TSA Form 1137-1 FINAL 260608.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 1137-1				Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18,000

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	34,200	34,200
Annual IC Cost Burden (Dollars)	3,486,680	3,486,680

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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