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
Disability Qualification Determination Form 1 Clean 8.29.24.docx	Form

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	N/A	Disability Qualification Determination	Form 1 Clean 8.29.24.docx		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: 74,102

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	74,102	74,102
Annual IC Time Burden (Hours)	37,051	37,051
Annual IC Cost Burden (Dollars)	1,144,135	1,144,135

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.