Information Collection Request
Disability Accommodation Request Form
ICR 202301-3045-006 · OMB 3045-0179 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3045-0179 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Disability Accommodation Reimbursement Request Form |
Form and Instruction | Modified | Repair queued |
 NCSA.pdf |
Supplementary Document | Uploaded 2023-01-31 | Repair queued |
| 30-Day Disability Reimbursement_01-31-2023.pdf |
Supplementary Document | Uploaded 2023-01-31 | Missing upstream |
| 60-Day Disability Reimbursement_87 FR 68139_11-14-2022.pdf |
Supplementary Document | Uploaded 2023-01-26 | Repair queued |
 20230103 Days of Services Instructions SSA_UPDATED.docx |
Supporting Statement A | Uploaded 2023-01-31 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 221228 |  Disability Accommodation Reimbursement Request Form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | CNCS |
| OMB Control No | 3045-0179 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202006-3045-003 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |