Information Collection

Filing a Claim

IC 43964 under ICR 202411-1652-007 · OMB 1652-0039.

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 Revised - sf95cover_packagerevised07-08-15-508.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: Required to Obtain or Retain Benefits

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	Revised - sf95cover_packagerevised07-08-15-508.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: 7,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,500	-1,500	9,000
Annual IC Time Burden (Hours)	3,750	-750	4,500
Annual IC Cost Burden (Dollars)	2,738	128	2,610

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.