Information Collection

TSA Claims Management System

IC 43964 under ICR 201111-1652-006 · OMB 1652-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0039 can be found here:

Documents and Forms

Document Name Document Type
Form SF 95 TSA Claims Management System Form
SF 95 Claim for Damage Injury or Death sf-95_claim_package.pdf www.tsa.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TSA Claims Management System	Agency IC Tracking Number:	1652-0039

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5(d)(2)(i)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 95	Claim for Damage Injury or Death	sf-95_claim_package.pdf	www.tsa.gov	Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,000	-10,800	22,800
Annual IC Time Burden (Hours)	6,000	-5,400	11,400
Annual IC Cost Burden (Dollars)	17,760	8,860	8,900

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.