Information Collection

Reasonable Accommodations for Employees and Applicants Tracking Form

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reasonable Accommodations for Employees and Applicants Tracking Form	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:

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 %

	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

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.