OMB control number
TSA Claims Application
OMB 1652-0039 · DHS/TSA.
The TSA adjudicates tort claims under the authority of the Federal Tort Claims Act (FTCA) (28 U.S.C. §§ 1346(b), 1402(b), 2401(b), 2671-2680). To thoroughly examine tort claims against the agency, TSA needs to collect additional information from claimants. The respondents to this collection are typically the traveling public, but may include others who have contact with TSA operations at various locations. Submission of a claim is entirely voluntary and initiated by individuals. Claimants typically file a claim by submitting to TSA a Standard Form 95 (SF-95), Claim for Damage, Injury, or Death, a form prescribed by the Department of Justice and approved under OMB control number 1105-0008. Because TSA requires further clarifying information in order to thoroughly examine their claim, claimants are asked to complete a Supplemental Information page added to the SF-95. For example, the Supplemental Information identifies the airport at which the incident occurred and states, if applicable, whether the incident occurred at a passenger security screening checkpoint or a checked baggage screening location. If the claim involves checked baggage, the Supplemental Information page identifies whether any third parties handled the checked bag and whether a checked bag was delayed. This information enables the claims examiner to promptly initiate a thorough investigation into the alleged loss and significantly reduces the time required to process the claim. This information also assists with identifying whether the claim should be more appropriately processed under the Military Personnel and Civilian Employees’ Claims Act (MPCECA).
The latest form for TSA Claims Application expires 2028-03-31 and can be found here.
Document Name |
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Form |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supporting Statement A |
Supplementary Document |
| Revision of a currently approved collection | 2024-12-17 | ||
|
Approved without change |
Extension without change of a currently approved collection | 2022-02-17 | |
|
Approved without change |
Revision of a currently approved collection | 2019-01-31 | |
|
Approved with change |
Extension without change of a currently approved collection | 2015-07-16 | |
|
Approved with change |
Extension without change of a currently approved collection | 2011-11-29 | |
|
Approved without change |
Revision of a currently approved collection | 2009-08-31 | |
|
Approved without change |
Existing collection in use without an OMB Control Number | 2006-06-09 |
Filing a Claim
Federal Enterprise Architecture: Homeland Security - Border and Transportation Security
| Form SF 95 | TSA Claims,Outreach, and Debt Branch Tort Claim Package | www.tsa.gov | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.