Individuals or Households

Reasonable Accommodation Requests, FCC Forms 5626 and 5627

OMB: 3060-1246

IC ID: 242629

Information Collection (IC) Details

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Individuals or Households OWD
No New
29 CFR 1630

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form FCC Form 5627 Medical Consent Form Medical Consent 7.8_final.docx Yes Yes Fillable Fileable Signable

General Government Central Fiscal Operations

EEOC/GOV-1, Equal Employment Opportunity (EEO) Complaint and Appeal Records   81 FR 81116

27 0
Individuals or Households
   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 54 0 0 54 0 0
Annual IC Time Burden (Hours) 142 0 0 142 0 0
Annual IC Cost Burden (Dollars) 1,700 0 0 1,700 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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