Information Collection

Disability Qualification Determination

IC 271765 under ICR 202410-3037-002 · OMB 3037-0012.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Disability Qualification Determination	Form
Form 3037-0012 Disability Qualification Determination Disability Qualification Determination	Form and Instruction
Disability Qualification Determination Form 1 Clean 8.29.24.docx	Form
3037-0012 Disability Qualification Determination Form 1 Disability Qualification Determination 3.7.2025.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 41 CFR 51-4.3 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3037-0012				Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 62,798

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	62,798	62,798
Annual IC Time Burden (Hours)	47,098	47,098
Annual IC Cost Burden (Dollars)	1,531,643	1,531,643

Documents for IC

table that charts IC Documents
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.

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