Reasonable Accommodation Requests, FCC Forms 5626 and 5627

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form 5627 Medical Consent Form	Form	New	Available
Form FCC Form 5626 Reasonable Accommodation Form with Questionnaire	Form	Modified	Available
3060-1246_final SS 072020.docx	Supporting Statement A	Uploaded 2020-07-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242629	Individuals or Households	Form	New	Medical Consent Form
227967	Federal Government	Form	Modified	Reasonable Accommodation Form with Questionnaire

ICR Details

OMB Control No: 3060-1246	ICR Reference No: 202006-3060-010
Status: Historical Active	Previous ICR Reference No: 201708-3060-012
Agency/Subagency: FCC	Agency Tracking No: OWD
Title: Reasonable Accommodation Requests, FCC Forms 5626 and 5627
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/09/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/09/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	10/31/2020
Responses	108	0	60
Time Burden (Hours)	284	0	312
Cost Burden (Dollars)	3,400	0	900

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Abstract: This information, completed on FCC Form 5626 and FCC Form 5637 will be used by the OWD to process, track, and maintain the confidentiality of reasonable accommodation requests.

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Authorizing Statute(s): EO: EO 13164 Name/Subject of EO: EEOC Policy GuidanceEstablishing Procedures to Facilitate the Provision of Reasonable Accommodation.
   US Code: 29 USC 791
   US Code: 29 USC 794
  

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:
	85 FR 27417	05/08/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 27417	05/08/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Federal Government	FCC Form 5626	Reasonable Accommodation Form with Questionnaire
Individuals or Households	FCC Form 5627	Medical Consent Form

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ICR Summary of Burden

table that charts list 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	108	60	0	0	48	0
Annual Time Burden (Hours)	284	312	0	0	-28	0
Annual Cost Burden (Dollars)	3,400	900	0	0	2,500	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The Commission is reporting adjustments to this information collection. The total number of respondents decreased by -6, the total annual responses increased by +48, the total annual burden hours decreased by -28 hours and the total annual costs increased by +$2,500. These calculations are based on the most currently available data to the Commission.

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Annual Cost to Federal Government: $123,903

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 07/09/2020

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