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Federal forms, ICRs, and supporting documents

Information Collection Request

Law Enforcement/Federal Air Marshal Service (OLE/FAMS) Physical and Mental Health Certification

ICR 201906-1652-001 · OMB 1652-0043 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form TSA Form 1164 Mental Health Certification Form and Instruction Modified Available
Form TSA Form 1163 Treating Physician Status Report Form and Instruction New Available
Form TSA Form 1133-3 Practical Exercise Performance Requirements (PEPR) form Form and Instruction New Available
privacy-pia-dhs-all043-hiring and onboarding-april2017.pdf Supplementary Document Uploaded 2019-06-04 Available
opm-sorn-govt-5-recruiting-examining-and-placement-records.pdf Supplementary Document Uploaded 2019-06-04 Repair queued
1652-0043 LEFAMS PMHC 30DN 84 FR 23062 (5.21.2019).pdf Supplementary Document Uploaded 2019-06-03 Repair queued
1652-0043 LEFAMS PMHC 60DN 83 FR 62878 (12.6.2018).pdf Supplementary Document Uploaded 2019-06-03 Repair queued
1652-0043 LEFAMS PMHC SS 6.3.2019.docx Supporting Statement A Uploaded 2019-06-04 Available
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 Available
49 USC 44901[1].doc Supplementary Document Uploaded 2007-08-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
46519 Mental Health Certification Form and Instruction Modified
236329 Treating Physician Status Report Form and Instruction New
236328 Practical Exercise Performance Requirements (PEPR) form Form and Instruction New
ICR Details
1652-0043 201906-1652-001
Active 201601-1652-004
DHS/TSA
Law Enforcement/Federal Air Marshal Service (OLE/FAMS) Physical and Mental Health Certification
Revision of a currently approved collection   No
Regular
Approved without change 07/14/2020
Retrieve Notice of Action (NOA) 07/31/2019
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved 07/31/2020
1,800 0 600
900 0 600
0 0 0
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 Law Enforcement/ Federal Air Marshal positions meet certain medical standards. The medical guidelines ensure a level of health status and physical and psychological fitness for this public safety law enforcement position which requires a high degree of responsibility. Medical guidelines are based on cognitive, physical, psychomotor, and psychological abilities related to the essential job functions of a FAM
US Code: 49 USC 44903 Name of Law: ATSA
   US Code: 49 USC 44917 Name of Law: ATSA
   US Code: 49 USC 44901 Name of Law: ATSA
  
None
Not associated with rulemaking
  83 FR 62878 12/06/2018
84 FR 23602 05/21/2019
Yes
  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 1,800 600 0 0 1,200 0
Annual Time Burden (Hours) 900 600 0 0 300 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Although there are no changes to the information being collected, as noted in the response to Item 2, the collection is being revised to include the following additional forms: (1) TSA Form 1163, Treating Physician Status Report (TPSR), and (2) TSA Form 1133-1, Practical Exercise Performance Requirements (PEPR), to assist in the determination and in conjunction with further evaluation requests as needed for applicants of a FAMs position or incumbent FAMs. Additionally, TSA is revising the name of the collection from “Office of Law Enforcement/Federal Air Marshal Service Mental Health Certification” to “Law Enforcement/Federal Air Marshal Service Physical and Mental Health Certification.” Finally, TSA is also revising the collection process to allow other authorized healthcare providers to certify the applicant’s or incumbent FAM’s medical status, when applicable. TSA has modified the PEPR form and the TPSR form to accept paperwork signed by an APRN in non-complex cases. TSA expects the modification of the forms will ease the burden of compliance by expanding the field of individuals, physician or APRN, who can be consulted to comply with the regulatory requirements. TSA will submit this collection as a Deregulatory Action. In Item 13, the change noted includes the removal of costs associated with mailing the documents. TSA revised the estimated cost to the Federal Government reported in Item 14 based on an update to the TSA wage rate and the number of respondents.
$3,175
No
    Yes
    Yes
No
No
No
No
Christina Walsh 571 227-2062 [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.
07/31/2019