Information Collection

Request for Reasonable Accommodation

IC 197899 under ICR 201105-0651-009 · OMB 0651-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PTO 158RA Request for Reasonable Accommodation	Form and Instruction
PTO 158RA Request for Reasonable Accommodation Aug_2011_PTO158RA_Draft_Form_0651-0012.doc	Form and Instruction

IC Title:

Request for Reasonable Accommodation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 11.7

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 and Instruction	PTO 158RA	Request for Reasonable Accommodation	Aug_2011_PTO158RA_Draft_Form_0651-0012.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	31	31

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.