Department of the Navy (DON) Reasonable Accommodations (RA) Tracker

Forms and Documents

Document Name	Status
Form SECNAV 12306/1T Confirmation of Reasonable Accommodation Request Form	New
DRAFT NM12905-1 NARRATIVE STATEMENT-SORN.docx Supplementary Document	2015-10-29
DRAFT DON AA_HRCP_PIA_revised_01_22_2015.pdf Supplementary Document	2015-10-29
DON RA Tracker Supporting_Statement_Part_A - Final.DOC Supporting Statement A	2015-10-29

IC Document Collections

IC ID	Document Title	Status
218795	Confirmation of Reasonable Accommodation Request Form	New

ICR Details

OMB Control No: 0703-0063	ICR Reference No: 201510-0703-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/NAVY	Agency Tracking No:
Title: Department of the Navy (DON) Reasonable Accommodations (RA) Tracker
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/30/2015
	Date Received in OIRA: 10/30/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved
Responses	100	0	0
Time Burden (Hours)	33	0	0
Cost Burden (Dollars)	1,543	0	0

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Abstract: Reasonable Accommodation Tracker is a new system that will be used by officials and employees of the DON in the performance of their official duty to track, monitor, review and process requests for reasonable accommodations by employees, contractors, and applicants for employment.

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Authorizing Statute(s): US Code: 10 USC 5041 Name of Law: Headquarters, Marine Corps
   US Code: 29 USC 701 Name of Law: Rehabilitation Act of 1973
   US Code: 42 USC 12101 Name of Law: Americans with Disabilities Act of 1990
   US Code: 10 USC 5013 Name of Law: Secretary of the Navy
   EO: EO 13163 Name/Subject of EO: Increasing the Opportunity for Individuals with Disabilities to Be Employed in the Federal Governmen
   EO: EO 13164 Name/Subject of EO: Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommo
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 36	01/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 66523	10/29/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Confirmation of Reasonable Accommodation Request	SECNAV 12306/1T	Confirmation of Reasonable Accommodation Request

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ICR Summary of Burden

	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	100	0	0	100	0	0
Annual Time Burden (Hours)	33	0	0	33	0	0
Annual Cost Burden (Dollars)	1,543	0	0	1,543	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $16,572

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/30/2015

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