OMB control number
Disability Qualification Determination
OMB 3037-0012 ยท CPBSD.
OMB 3037-0012
The form will be used by the AbilityOne Program to determine eligibility as a qualified direct labor employee whose work will be counted as hours performed by a blind or significantly disabled individual as required by the JWOD Act (41 USC 85) U.S. AbilityOne Commission Compliance Policy 51.403.
The latest form for Disability Qualification Determination expires 2028-03-31 and is listed under ICR 202410-3037-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Disability Qualification Determination | Form |
 Redlined IEE.pdf | Supplementary Document |
| Form 1 supporting statement - Inspected.docx | Supporting Statement A |
| 2024-24384.pdf | Supplementary Document |
 INDIVIDUAL ELIGIBILITY EVALUATION (3).dotx | Supplementary Document |
| Commission Policy 51.403 Determining Eligibility of Participating Employees signed-2Aug2024-a.pdf | Supplementary Document |
| 41 CFR 51-4.3 (up to date as of 10-09-2024) (1).pdf | Supplementary Document |
| form 1 60-day notice 2023-25499.pdf | Supplementary Document |
| Form 1 30-day Notice.docx | Supplementary Document |
 Disability Qualification Determination |
Form |
| Individual Eligibility Evaluation Form |
Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202410-3037-002 | Reinstatement with change of a previously approved collection | 2024-10-24 | ||
| 201204-3037-001 | New collection (Request for a new OMB Control Number) | 2012-09-17 | Approved without change |
OMB Details
Individual Eligibility Evaluation Form
Federal Enterprise Architecture: Economic Development - Business and Industry Development
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form 3037-0011 | Individual Eligibility Eligibility | Paper Only | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.