Information Collection

Reasonable Accommodations for Employees and Applicants Tracking Form

IC 4817 under ICR 200704-0690-001 · OMB 0690-0022.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CD-575 Reasonable Accommodations for Employees and Applicants Tracking Form	Form
CD-575 Reasonable Accommodations for Employees and Applicants w 0690.0022.CD575Form.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CD-575	Reasonable Accommodations for Employees and Applicants with Disabilities Tracking Form	0690.0022.CD575Form.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.