TSO Medical Questionnaire and Evaluation

Transportation Security Officer Medical Questionnaire

OMB: 1652-0032

IC ID: 191700

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

TSO Medical Questionnaire and Evaluation
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction TSA Form 1130A-1 TSO Medical Questionnaire TSA_Form_1130A-1_FINAL_01 14 10 (3).pdf No   Paper Only
Form and Instruction TSA Form 1130B-1 Cancer Further Evaluation CANCER - TSA_Form_1130B-1_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-2 Cardiac Further Evaluation CARDIAC - TSA_Form_1130B-2_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-3 Cardiac Surgery Further Evaluation CARDIAC SURGERY- TSA_Form_1130B-3_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-4 Diabetes Further Evaluation DIABETES - TSA_ Form_1130B-4_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-5 Drug Use Further Evaluation DRUG USE - TSA_Form_1130B-5_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-6 General Medical Further Evaluation GENERAL MED - TSA_Form_1130B-6_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-7 Hearing Further Evaluation HEARING - TSA_Form_1130B-7_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-8 Hepatitis Further Evaluation HEPATITIS - TSA_Form_1130B-8_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-9 Hernia Further Evaluation HERNIA - TSA_Form_1130B-9_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-10 HIV Further Evaluation HIV - TSA_Form_1130B-10_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-11 Pacemaker Further Evaluation PACEMAKER - TSA_Form_1130B-11_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-12 Mental Health Further Evaluation MENTAL HEALTH - TSA_Form_1130B-12_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-13 Orhopedic ORTHOPEDIC - TSA_Form_1130B-13_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-14 Palmar Further Evaluation PALMAR - TSA_Form_1130B-14_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-15 Respiratory Further Evaluation RESPIRATORY - TSA_Form_1130B-15_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-16 Seizure Further Evaluation SEIZURE - TSA_Form_1130B-16_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-17 TB Further Evaluation TB - TSA_Form_1130B-17_ FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-18 Vision Further Evaluation VISION - TSA_Form_1130B-18_FINAL_01.08.10.docx No   Paper Only
Form and Instruction TSA Form 1130B-19 Vital Signs Further Evaluation VITAL SIGNS - TSA_Form_1130B-19_FINAL_ 01.08.10.docx No   Paper Only

Homeland Security Border and Transportation Security

 

26,565 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 26,565 0 26,565 0 0 0
Annual IC Time Burden (Hours) 12,912 0 12,912 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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