Civil Rights and Disability

1652-0030
Complaint Form
Category: Civil Rights and/or Civil Liberties

COMPLAINT 1 OF 5

COMPLAINT 2 OF 5

COMPLAINT 3 OF 5

COMPLAINT 4 OF 5

COMPLAINT 5 OF 5

Privacy Act Statement:


AUTHORITY: 49 USC § 114(f)(15). PRINCIPAL
PURPOSE(S): This information will be used to manage
and respond to traveler inquiries or complaints.
ROUTINE USE(S): This information may be shared in
accordance with the Privacy Act of 1974, 5 USC §
552(a), for routine uses identified in the TSA system of
records, DHS/TSA-006 Correspondence and Matters
Tracking Records, or as further described in the
Privacy Impact Assessment DHS/TSA/PIA-046 TSA
Contact Center, and subsequent updates, available
at www.dhs.gov/privacy. DISCLOSURE: Furnishing this
information is voluntary; however, failure to provide
the requested information may prevent TSA from
being able to respond to a traveler’s inquiry or
complaint.

Paperwork Reduction Act Statement:


TSA will use the information to improve customer service and may
share it with airport operators for this purpose. This is a voluntary
collection. It is estimated that the total annual burden per
response associated to this collection is approximately 8 minutes.
An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information, unless it
displays a valid OMB control number. The control number
assigned to this collection is OMB-1652-0030, which expires
8/31/2025. Send comments regarding this burden estimate or any
other aspect of this collection of information including
suggestions for reducing this burden to TSA PRA Officer, 6595
Springfield Center Drive, Springfield, VA 20598-6011. ATTN: PRA
1652-0030.

PRIVACY ACT & PAPERWORK
REDUCTION ACT STATEMENTS