National Disability Formum (NDF) and Post-Call Surveys

NDF OMB Package "Approved, OMB Number ____________”

NDF REGISTRATION PAGE REQUEST FORM

ONIA Requester:

Who to ‘cc on daily update emails:

Opening (Release) date of registration page link:

Closing date of registration page link:

Event Information

• Title:

• Date:

• Location:

• Time:

Please attach in email any special Header & Footer Banners (both should be approx. 912 x 300 pixels):

NDF Registration Page Information (* means required info)

(Please make edits to this document if you require changes &

questions with * means required to answer)

*Prefix:

* First name:

MI:

* Last name:

*Phone number:

* Email address:

* Name of your organization:

* Organization type:

• Federal Government

• State Government

• Local Government

• Private

• Nonprofit

• College/University

• Health

• Faith-Based

• Military

• Other (Please Specify)

* Job title

*Are you an employee of the Social Security Administration (SSA)?

• Yes

• No

* How will you participate?

• By phone

• In-person

* Do you require special accommodation?

If yes, please explain:

How did you hear about this event?

• Dear Colleague Letter

• Email

• Social Media (i.e. Facebook or Twitter)

Twitter handle

***OMECO will report daily registration updates before noon. ***