Information Collection

Script for Reasonable Accommodation Submission

IC 275474 under ICR 202505-3124-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Script for Reasonable Accommodation Submission	Form
Script for Reasonable Accommodation Request Script for Reasonable Accommodation Submission	Form
Script for Reasonable Accommodation Request SCRIPT~1.PDF	Form
Script for Reasonable Accommodation Request SCRIPT~1.PDF	Form

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	N/A				Yes	No	Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: Reasonable Accommodation

FR Citation: 86 FR 73001

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	1,895	1,895

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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