Information Collection Submission for MSPB Reasonable Accommodation Requests

Forms and Documents

Document Name	Status
Script for Reasonable Accommodation Submission Form	New
Accommodation Request Form Form and Instruction	New
MSPB 3124-00xx (RA Request Form) Supporting Statement A (7.1.2025).docx Supporting Statement A	2025-07-02

IC Document Collections

IC ID	Document Title	Status
275474	Script for Reasonable Accommodation Submission Form	New
275473	Accommodation Request Form Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202505-3124-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: MSPB	Agency Tracking No:
Title: Information Collection Submission for MSPB Reasonable Accommodation Requests
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/02/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	90	0
Time Burden (Hours)	70	0
Cost Burden (Dollars)	2,653	0

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Abstract: This collection is part of MSPB’s compliance efforts to collect information to facilitate adjudication of reasonable accommodation requests by employees of or applicants to the MSPB, and by participants in MSPB programs, e.g., parties to appeals, respondents to surveys, etc. See The Rehabilitation Act of 1973, 29 U.S.C. 701, 791, 794; title VII of the Civil Rights Act of 1964, 42 U.S.C. 2000e; 29 CFR part 1605 (Guidelines on Discrimination Because of Religion); 29 CFR part 1614 (Federal Sector Equal Employment Opportunity); 29 CFR part 1630 (Regulations to Implement the Equal Employment Provisions of the Americans With Disabilities Act); E.O. 13164, Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommodation (July 26, 2000); and E.O. 13548, Increasing Federal Employment of Individuals with Disabilities (July 26, 2010); The Pregnant Workers Fairness Act (effective June 27, 2023). Responses to any collection of information under this ICR are voluntary.

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Authorizing Statute(s): US Code: 29 USC 701 Name of Law: The Rehabilitation Act of 1973
   US Code: 29 USC 791 Name of Law: The Rehabilitation Act of 1973
   US Code: 29 USC 794 Name of Law: The Rehabilitation Act of 1973
   US Code: 42 USC 2000e Name of Law: Title VII of the Civil Rights Act of 1964
   US Code: 42 USC 218d Name of Law: Providing Urgent Maternal Protections for Nursing Mothers Act
   US Code: 42 USC 2000gg Name of Law: Pregnant Workers Fairness Act
   EO: EO 13164 Name/Subject of EO: Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommo
   EO: EO 13548 Name/Subject of EO: Increasing Federal Employment of Individuals with Disabilities (July 26, 2010)
  

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:
	90 FR 4804	01/16/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 23068	05/30/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Accommodation Request Form	N/A	Accommodation Request Form
Script for Reasonable Accommodation Submission	N/A	Script for Reasonable Accommodation Request

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ICR Summary of Burden

	Total Request	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	90	0	0	90	0	0
Annual Time Burden (Hours)	70	0	0	70	0	0
Annual Cost Burden (Dollars)	2,653	0	0	2,653	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: There is a burden increase because this is a new collection.

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Annual Cost to Federal Government: $201,444

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.     Yes

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.     Yes

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: 07/02/2025

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