Reasonable Accommodation Requests, FCC Forms 5626 and 5627

Forms and Documents

Document	Type	Status	Availability
Form FCC Form 5627 Medical Consent Form	Form	Modified	Available
Form FCC Form 5626 Reasonable Accommodation Form with Questionnaire	Form	Modified	Available
3060-1246_final version_2026.docx	Supporting Statement A	Uploaded 2026-04-08	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
242629	Individuals or Households	Form	Modified	Medical Consent Form
227967	Federal Government	Form	Modified	Reasonable Accommodation Form with Questionnaire

ICR Details

OMB Control No: 3060-1246	ICR Reference No: 202604-3060-003
Status: Active	Previous ICR Reference No: 202306-3060-003
Agency/Subagency: FCC	Agency Tracking No: OWD
Title: Reasonable Accommodation Requests, FCC Forms 5626 and 5627
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/28/2026
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2029	36 Months From Approved	06/30/2026
Responses	328	0	36
Time Burden (Hours)	850	0	98
Cost Burden (Dollars)	3,400	0	3,400

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Abstract: This information, completed on FCC Form 5626 and FCC Form 5627 will be used by the OWD to process, track, and maintain the confidentiality of reasonable accommodation requests.

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Authorizing Statute(s): EO: EO 13164 Name/Subject of EO: EEOC Policy GuidanceEstablishing Procedures to Facilitate the Provision of Reasonable Accommodation.
   US Code: 29 USC 791
   US Code: 29 USC 794
  

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:
	91 FR 9616	02/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 9616	02/26/2026
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Federal Government	FCC Form 5626	Reasonable Accommodation Form with Questionnaire
Individuals or Households	FCC Form 5627	Medical Consent Form

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ICR Summary of Burden

	Total Approved	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	328	36	0	0	292	0
Annual Time Burden (Hours)	850	98	0	0	752	0
Annual Cost Burden (Dollars)	3,400	3,400	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Commission is reporting adjustments to this information collection. The total number of respondents increased by +146, the total annual responses increased by +292, and the total annual burden hours increased by +752 hours. These adjustments/increases are due to more filings of FCC Forms 5626 and 5627 received since the last submission to OMB. There are no program changes.

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Annual Cost to Federal Government: $420,973

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: 04/28/2026

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