20191227 Justification Disability Form

20191227 Justification Disability Form.doc

Disability Accommodation Request Form

OMB: 3045-0179

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SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSIONS

 

A. Justification


A1. Need for Information Collection


The Corporation for National and Community Service (CNCS) awards grants to states, institutions of higher education, non-profit organizations, Indian tribes, and U.S. Territories to operate AmeriCorps State, AmeriCorps National, AmeriCorps NCCC, AmeriCorps VISTA and Senior Corps programs. This information collection allows CNCS grantees to request reimbursement for services associated with reasonable accommodation of AmeriCorps service members.


A2. Indicate how, by whom, and for what purpose the information is to be used.


The form allows CNCS to collect information from grantees requesting reimbursement for services associated with reasonable accommodations of AmeriCorps service members.

 

 A3. Minimize Burden: Use of Improved Technology to Reduce Burden


The information will be collected electronically via email by submission of this form and the receipt(s) for services.


A4. Non-Duplication


There are no other sources of information by which CNCS can meet the purposes described in A2 (above).

 

A5. Minimizing for economic burden for small businesses or other small entities.


This collection of information does not impact small businesses because they are not eligible to apply for grants. There is no economic burden to any other small entities beyond the cost of staff time to collect and report the data. This is minimized to the degree possible by only asking for the information necessary to receive an organization’s request for reimbursement for services associated with reasonable accommodations of AmeriCorps service members.

 

A6. Consequences of the collection if not conducted, conducted less frequently, as well as any technical or legal obstacles to reducing burden.

 

The Corporation will be unable to for collect the needed information to provide reimbursement to grantees for services associated with reasonable accommodations of AmeriCorps service members.


A7. Special circumstances that would cause information collection to be collected in a manner requiring respondents to report more often than quarterly; report in fewer than 30 days after receipt of the request; submit more than an original and two copies; retain records for more than three years; and other ways specified in the Instructions focused on statistical methods, confidentially, and proprietary trade secrets.


There are no special circumstances that would require the collection of information in these ways.


A8. Provide copy and identify the date and page number of publication in the Federal Register of the Agency’s notice. Summarize comments received and actions taken in response to comments. Specifically address comments received on cost and hour burden.


The 60-day Notice soliciting comments was published on Friday, June 7, 2019 on page 26659. No comments were received.

 

 A9. Payment to Respondents


There are no payments or gifts to respondents

  

A10. Assurance of Confidentiality and its basis in statute, regulation, or agency policy.


Responses to this information collection will be disclosed as appropriate unless prohibited by law. CNCS is required by the Privacy Act of 1974, as amended, (5 U.S.C. 552a) to tell you what personal information we collect and how it will be used: Your personal information is requested pursuant to the National Service Trust Act of 1993 (42 USC 12611), section 12617. It will be used to assess eligibility for AmeriCorps State and National grantees to receive reimbursement for reasonable accommodations to due member disability. Routine uses of this information may include assessing such eligibility. This request is required for AmeriCorps State and National grantees receive reimbursement for reasonable accommodation.


A11. Sensitive Questions

 

The information collection does not include questions of a sensitive nature.

 

A12. Hour burden of the collection

The purpose of this form is to collect information from grantees requesting reimbursement for services associated with reasonable accommodations of AmeriCorps service members.

We expect approximately 20 respondents to use the form to request reimbursement for services associated with reasonable accommodations of AmeriCorps service members. Each response will take nine minutes. The total estimated number of annual burden hours is three hours. There is no estimated annual hour burden outside of the customary and usual business practices.

 

A13. Cost burden to the respondent


There is no cost to the respondent.

 

A14. Cost to Government


Cost

Pay Band

Salary*

% of Effort

Fringe if applicable

Total Cost to Government

Federal Oversight

NY-3

$91,268

1%


$913

Contractor Cost





0







Total





$913


A15. Reasons for program changes or adjustments in burden or cost.


Not applicable.

 

 A16. Publication of results


This information will not be published. 

 

A17. Explain the reason for seeking approval to not display the expiration date for OMB approval of the information collection.


Not applicable.

 

 A18. Exceptions to the certification statement


There are no exceptions to the certification statement in the submitted ROCIS form.


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File Typeapplication/msword
File TitleAttached is the final version with some differences with RPD about the costs defiend in A12 and not included in A13
Authorvperry
Last Modified BySYSTEM
File Modified2019-12-27
File Created2019-12-27

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