OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Submitting Payment Information

IC 234085 under ICR 202411-1652-007 · OMB 1652-0039.

Documents and Forms
Document Name
Document Type
Other-Letter
Other-Letter
Other-Letter
Other-Letter
Other-PRA Stmt Mockup
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Submitting Payment Information
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Letter 0-0-1 Approval.rtf Yes Yes Fillable Printable
Other-Letter 0-0-2 Settlement.rtf Yes Yes Fillable Printable
Other-Letter 0-0-9 Reeval- Settlement.rtf Yes Yes Fillable Printable
Other-Letter 0-0-10 Reeval -Settlement 50%.rtf Yes Yes Fillable Printable
Form and Instruction 600 Authorization for Disclosure of Protected Health Information Pursuant to HIPAA TSA-Form600_FINALv240603 (1).pdf Yes Yes Fillable Fileable
Other-PRA Stmt Mockup TSA-Form600_FINALv240603 (1_PRAstmt).docx Yes Yes Fillable Fileable

Homeland Security Border and Transportation Security

DHS/TSA 013 DHS Claims Records  73 FR 63987

900 0
   
Individuals or Households
 
   50 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 900 0 0 -350 0 1,250
Annual IC Time Burden (Hours) 150 0 0 -58 0 208
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.