OMB control number
Disability Accommodation Request Form
OMB 3045-0179 ยท CNCS.
OMB 3045-0179
This form is completed by AmeriCorps State and National grantees who want to receive reimbursement for funds spent accommodating AmeriCorps members with disabilities.
The latest form for Disability Accommodation Request Form expires 2026-08-31 and is listed under ICR 202301-3045-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 AmeriCorps Member Disability Accommodation Off Set Reimbursement Request Form | Form and Instruction |
 ASC Disability Request Form comment March 2026.pdf | Public Comments |
| 30-Day Disability Reimb_91 FR 15975.pdf | Supplementary Document |
| 60-Day Disability Reimbursement_01-29-2026.pdf | Supplementary Document |
| NCSA.pdf | Supplementary Document |
| ASN Disability Accommodations SSA_2026_FINAL.docx | Supporting Statement A |
 Disability Accommodation Reimbursement Request Form |
Form and Instruction |
| Disability Accommodation Reimbursement Request Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202602-3045-004 | Extension without change of a currently approved collection | 2026-03-31 | ||
| 202301-3045-006 | Extension without change of a currently approved collection | 2023-01-31 | Approved with change | |
| 202006-3045-003 | No material or nonsubstantive change to a currently approved collection | 2020-06-25 | Approved without change | |
| 201909-3045-002 | Reinstatement without change of a previously approved collection | 2019-09-10 | Approved with change | |
| 201604-3045-002 | New collection (Request for a new OMB Control Number) | 2016-04-22 | Approved with change |