Information Collection

Accommodation Request Form

IC 275473 under ICR 202505-3124-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Accommodation Request Form	Form and Instruction
Accommodation Request Form Accommodation Request Form	Form and Instruction
Accommodation Request Form RA Form (May 2025) - 508.pdf	Form and Instruction
Accommodation Request Form RA Form (May 2025) - 508.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	N/A				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: MSPB - 3 Reasonable Accommodation

FR Citation: 86 FR 73001

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	758	758

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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