Nomination Form

Excellence in Disability Inclusion Award

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1250-0010 can be found here:

Documents and Forms

Document Name Document Type
Form EDI Form Nomination Form Form and Instruction
EDI Form EDI Form OFCCP_EDI Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Nomination Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	EDI Form	EDI Form	OFCCP_EDI Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 67	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	67	67
Annual IC Time Burden (Hours)	1,441	1,441
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.