OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Office of Law Enforcement/Federal Air Marshal Service (OLE/FAMS) Mental Health Certification

ICR 201210-1652-002 · OMB 1652-0043 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form TSA 1164 FAMS Mental Health Certification Form Modified Available
1652_0043 30 Day.pdf Supplementary Document Uploaded 2012-11-01 Repair queued
1652_0043 60 Day.pdf Supplementary Document Uploaded 2012-11-01 Available
1652_0043 Supporting Statement.doc Supporting Statement A Uploaded 2012-11-01 Repair queued
DHS-TSA 001.pdf Supplementary Document Uploaded 2010-09-24 Available
OPM-GOVT-10%20-%20Medical%20Records[1].pdf Supplementary Document Uploaded 2010-09-24 Repair queued
49 USC 44917[1].doc Supplementary Document Uploaded 2007-08-29 Available
49 USC 44903[1].doc Supplementary Document Uploaded 2007-08-29 Repair queued
49 USC 44901[1].doc Supplementary Document Uploaded 2007-08-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
46519 FAMS Mental Health Certification Form Modified
ICR Details
1652-0043 201210-1652-002
Historical Active 201009-1652-001
DHS/TSA
Office of Law Enforcement/Federal Air Marshal Service (OLE/FAMS) Mental Health Certification
Extension without change of a currently approved collection   No
Regular
Approved without change 03/22/2013
Retrieve Notice of Action (NOA) 12/31/2012
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved 03/31/2013
600 0 10,000
600 0 10,000
270 0 4,400
In furtherance of TSA's authority to provide for deployment of Federal Air Marshals (FAMs) on passenger flights, and provide for appropriate training, supervision, and equipment of FAMs TSA policy requires that applicants for Office of Law Enforcement/ Federal Air Marshal positions meet certain medical standards, which includes a psychological evaluation. Applicants will be required to complete a certification regarding their mental health history and provide an explanation for anything they cannot certify. This certification is carefully geared to capitalize on other elements of the assessment process, such as personal interviews, physical task assessment, background investigation, as well as the other components of the medical examination and assessment.
US Code: 49 USC 44901 Name of Law: ATSA
   US Code: 49 USC 44903 Name of Law: ATSA
   US Code: 49 USC 44917 Name of Law: ATSA
  
None
Not associated with rulemaking
  77 FR 42751 07/20/2012
77 FR 65701 10/30/2012
No
1
IC Title Form No. Form Name
FAMS Mental Health Certification TSA 1164 Mental Health Certification
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 10,000 0 0 -9,400 0
Annual Time Burden (Hours) 600 10,000 0 0 -9,400 0
Annual Cost Burden (Dollars) 270 4,400 0 0 -4,130 0
No
No
The estimated hour burden reported in Item 13 has been revised because TSA has lowered its estimate of the number of respondents to 600 based on projections from fiscal year 2011. The estimated cost to respondents reported in Item 14 has been revised because TSA has lowered its estimate of the number of respondents to 600, and because the cost of first class stamps has increased from $.44 to $.45.
$2,000
No
No
No
No
No
Uncollected
Susan Perkins 571 227-3398 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/31/2012