Reasonable Accommodation Forms

Forms related to Reasonable Accommodation for Personal Health and Religious Information

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0196 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Reasonable Accommodation Forms Form
1 Reasonable Accommodation: Medical Exemption Request COVID 19 Medical Exemption writable.pdf www.nationalservice.gov Form
2 Reasonable Accommodation: Medical Request Medical Reasonable Accommodation writable.pdf www.nationalservice.gov Form
3 Reasonable Accommodation Form: Religious Religious Accommdation Form writable.pdf www.nationalservice.gov Form
3 Request Religious Exemption Request COVID 19 Religious Exemption writable.pdf www.nationalservice.gov Form

Information Collection (IC) Details

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents:	Number of Respondents for Small Entity:

Affected Public:

Percentage of Respondents Reporting Electronically:

		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
Annual IC Time Burden (Hours)
Annual IC Cost Burden (Dollars)

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.