Disability Accommodation Request Form

Disability Accommodation Request Form

OMB: 3045-0179

IC ID: 221228

Information Collection (IC) Details

View Information Collection (IC)

Disability Accommodation Request Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Disability Accommodation Request Form Disability Request Form_FINAL wPRA and Privacy.docx www.nationalservice.gov Yes Yes Fillable Fileable
Form and Instruction 1 2019 Disability Accommodation Request Form Disability Accommodation Form.pdf www.nationalservice.gov Yes Yes Fillable Fileable
Form and Instruction 1 Disability Accommodation Request Form 20191227 Disability Request Form_FINAL wPRA and Privacy.docx www.nationalservice.gov Yes Yes Fillable Fileable

Community and Social Services Community and Regional Development

 

20 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 20 0 0 0 20 0
Annual IC Time Burden (Hours) 3 0 0 0 3 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Authorizing Citation Disability Accommodation Authorizing Citation.pdf 09/10/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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