Information Collection

LEO Reimbursement Request Form

IC 205274 under ICR 201510-1652-002 · OMB 1652-0063.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1652-0063 can be found here:

Documents and Forms

Document Name Document Type
Form TSA Form 3503 (1/1 LEO Reimbursement Request Form Form and Instruction
TSA Form 3503 (1/1 LEO Reimbursement Request-Invoice LEO Reimbursement Request Form.xls Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LEO Reimbursement Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 49 CFR 106 (f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TSA Form 3503 (1/15) [File: 3500.8.5]	LEO Reimbursement Request-Invoice	LEO Reimbursement Request Form.xls		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: 326	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,912	3,912
Annual IC Time Burden (Hours)	3,912	3,912
Annual IC Cost Burden (Dollars)	0	0

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.