Information Collection

FEMA Reasonable Accommodation Medical Request Form (FEMA Form FF-256-FY-25-100)

IC 278716 under ICR 202601-1660-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-256-F FEMA Reasonable Accommodation Medical Request Form FEMA Reasonable Accommodation Medical Request Form (FEMA Form FF-256-FY-25-100)	Form and Instruction
FEMA Form FF-256-F FEMA Reasonable Accommodation Medical Request Form FEMA Form FF-256-FY-25-100_DRAFT.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	FEMA Form FF-256-FY-25-100				Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/ALL-033 Reasonable Accommodatoins Records

FR Citation: 87 FR 19111

Number of Respondents: 232

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	232	232
Annual IC Time Burden (Hours)	116	116
Annual IC Cost Burden (Dollars)	0	0

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].