Online TSO Medical Questionnaire

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TRANSPORTATIONSECURITYOFFICERMEDICALQUESTIONNAIRE

OMB control number 1652-0032
Expiration 12/31/2026

Public Burden
and Privacy
Act
Statements.
Instructions

Health Care
Provider
Information

Demographic
Information

General
Information

Vision and
Hearing

Respiratory

Cardiovascular

Cardiovascular
2 of 2

Abdominal
Organs and
Renal

Musculosketal

Neurological
1of 2

Neurological 2
of 2

Endocrine

Sleep
Disorders

Psychological 1
of 2

Psychological
2 of 2

Activity 1 of 2

Activity 2 of 2

PRA
STATEMENT

 Public Burden Statement: TSA is collecting the information to
determine suitability to serve as a Transportation Security Officer
(TSO). This is a voluntary collection of information; however,
failure to furnish the requested information may result in an
inability to consider your eligibility for employment as a TSO. TSA
estimates that the total average burden per response associated
with this collection is approximately 0.50 hours, including the time
for reviewing instructions and getting needed information. An
agency may not conduct or sponsor, and a person is not required
to respond to a collection of information unless it displays a valid
OMB control number. The OMB control number assigned to this
collection of information is 1652-0032, which expires on
12/31/2026. Send comments regarding our estimate or any other
aspect of this form, including suggestions for reducing burden to
DHS/TSA, [email protected] or TSA-11, Transportation
Security Administration, 6595 Springfield Center Drive,
Springfield, Virginia 20598-6011. Attn: PRA 1652-0032
Transportation Security Officer Medical Questionnaire.