Information Collection

Filing a Claim

IC 43964 under ICR 202202-1652-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Filing a Claim Form
SF 95 TSA Claims,Outreach, and Debt Branch Tort Claim Package sf_95_cover_package 1-26-22.pdf www.tsa.gov Form
SF 95 TSA Claims,Outreach, and Debt Branch Tort Claim Package sf_95_cover_package 1-26-22.pdf www.tsa.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Filing a Claim	Agency IC Tracking Number:	1652-0039

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 14.2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 95	TSA Claims,Outreach, and Debt Branch Tort Claim Package	sf_95_cover_package 1-26-22.pdf	www.tsa.gov	Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: DHS Claims Records	FR Citation: 73 FR 63987

Number of Respondents: 9,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,000	-1,200	10,200
Annual IC Time Burden (Hours)	4,500	-600	5,100
Annual IC Cost Burden (Dollars)	2,610	60	2,550

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.