Disability Accommodation Reimbursement Request Form

Disability Accommodation Request Form

OMB: 3045-0179

IC ID: 221228

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Form and Instruction
Other-REDLINED
Other-REDLINED
Form and Instruction
Form and Instruction
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IC Document
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Disability Accommodation Reimbursement 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 and Instruction N/A AmeriCorps Member Disability Accommodation Off Set Reimbursement Request Form FY2023_Form.docx Yes Yes Fillable Fileable
Other-REDLINED Form_REDLINED_2019-2023.docx 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 0 20
Annual IC Time Burden (Hours) 7 0 0 4 0 3
Annual IC Cost Burden (Dollars) 279 0 0 279 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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