Request for Reasonable Accommodation

ICR 200307-0690-001

OMB: 0690-0022

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
4817 Migrated
ICR Details
0690-0022 200307-0690-001
Historical Active
DOC/OS
Request for Reasonable Accommodation
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/28/2003
Retrieve Notice of Action (NOA) 07/17/2003
  Inventory as of this Action Requested Previously Approved
08/31/2006 08/31/2006
20 0 0
2 0 0
0 0 0

Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodation to qualified employees or applicants with disabilities unless to do so would cause undue hardship. The Department is committed to providing reasonable accommodations to qualified individuals with disabilities be they employees or applicants for employment. Unless an accommodation would pose an undue hardship, the Department will provide reasonable accommodation to a qualified individual with a disability who is an: a. applicant who needs an accommodation in order to be considered for a job; b. employee who needs an

None
None


No

1
IC Title Form No. Form Name
Request for Reasonable Accommodation 575

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 20 0 0 20 0 0
Annual Time Burden (Hours) 2 0 0 2 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/17/2003


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