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Disability Accommodation Reimbursement Request Form
Disability Accommodation Request Form
OMB: 3045-0179
IC ID: 221228
OMB.report
CNCS
OMB 3045-0179
ICR 202602-3045-004
IC 221228
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Disability Accommodation Reimbursement Request Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
N/A
AmeriCorps Member Disability Accommodation Off Set Reimbursement Request Form
Disability Reimbursement Form ASN_2026-FINAL.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20
0
0
0
0
20
Annual IC Time Burden (Hours)
7
0
0
0
0
7
Annual IC Cost Burden (Dollars)
320
0
0
41
0
279
Documents for IC
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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