Disability Qualification Determination

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3037-0012 Disability Qualification Determination	Form and Instruction	New	Repair queued
Disability Qualification Determination	Form	New	Repair queued
Form 3037-0011 Individual Eligibility Eligibility	Form	Removed	Available
INDIVIDUAL ELIGIBILITY EVALUATION (3).dotx	Supplementary Document	Uploaded 2025-01-28	Repair queued
Redlined IEE.pdf	Supplementary Document	Uploaded 2024-10-24	Repair queued
Redlined IEE.pdf	Supplementary Document	Uploaded 2024-10-24	Repair queued
Form 1 Supporting Statement_CLEAN 1.17.2025.docx	Supporting Statement A	Uploaded 2025-01-28	Repair queued
Form 1 supporting statement - Inspected.docx	Supporting Statement A	Uploaded 2024-10-24	Repair queued
2024-24384.pdf	Supplementary Document	Uploaded 2024-10-22	Available
2024-24384.pdf	Supplementary Document	Uploaded 2024-10-22	Repair queued
INDIVIDUAL ELIGIBILITY EVALUATION (3).dotx	Supplementary Document	Uploaded 2024-10-21	Available
INDIVIDUAL ELIGIBILITY EVALUATION (3).dotx	Supplementary Document	Uploaded 2024-10-21	Repair queued
Commission Policy 51.403 Determining Eligibility of Participating Employees signed-2Aug2024-a.pdf	Supplementary Document	Uploaded 2024-10-21	Available
Commission Policy 51.403 Determining Eligibility of Participating Employees signed-2Aug2024-a.pdf	Supplementary Document	Uploaded 2024-10-21	Available
41 CFR 51-4.3 (up to date as of 10-09-2024) (1).pdf	Supplementary Document	Uploaded 2024-10-21	Available
41 CFR 51-4.3 (up to date as of 10-09-2024) (1).pdf	Supplementary Document	Uploaded 2024-10-21	Repair queued
form 1 60-day notice 2023-25499.pdf	Supplementary Document	Uploaded 2024-10-21	Repair queued
form 1 60-day notice 2023-25499.pdf	Supplementary Document	Uploaded 2024-10-21	Repair queued
Form 1 30-day Notice.docx	Supplementary Document	Uploaded 2024-10-21	Available
Form 1 30-day Notice.docx	Supplementary Document	Uploaded 2024-10-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
271765	Disability Qualification Determination	Form and Instruction	New	Disability Qualification Determination
271765	Disability Qualification Determination	Form	New
204092	Individual Eligibility Evaluation Form	Form	Removed	Individual Eligibility Eligibility
204092	Individual Eligibility Evaluation Form	Instruction	Removed

ICR Details

OMB Control No: 3037-0012	ICR Reference No: 202410-3037-002
Status: Active	Previous ICR Reference No: 201204-3037-001
Agency/Subagency: CPBSD	Agency Tracking No: 2012-3037-0011
Title: Disability Qualification Determination
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/17/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/24/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2028	36 Months From Approved
Responses	62,798	0	0
Time Burden (Hours)	47,098	0	0
Cost Burden (Dollars)	1,531,643	0	0

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Abstract: The form will be used by the AbilityOne Program to determine eligibility as a qualified direct labor employee whose work will be counted as hours performed by a blind or significantly disabled individual as required by the JWOD Act (41 USC 85) U.S. AbilityOne Commission Compliance Policy 51.403.

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Authorizing Statute(s): US Code: 41 USC 85 Name of Law: COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED
  

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:
	88 FR 221	11/17/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 204	10/22/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Disability Qualification Determination	3037-0012	Disability Qualification Determination
Individual Eligibility Evaluation Form	3037-0011	Individual Eligibility Eligibility

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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	62,798	0	0	62,798	-46,354	46,354
Annual Time Burden (Hours)	47,098	0	0	47,098	-386	386
Annual Cost Burden (Dollars)	1,531,643	0	0	1,531,643	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The new form will be required the first year for all direct labor employees. This number will dramatically be reduced in year two and beyond.

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Annual Cost to Federal Government:

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.     No

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.     No

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: 10/24/2024

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