OMB control number
Requests for Medical and Religious Reasonable Accommodation
OMB 3045-0196 · CNCS.
OMB 3045-0196
AmeriCorps seeks to revise the current information collection, which was for requests for health and religious accommodations that were specific to seeking exemptions from the COVID-19 vaccination requirement, but with this revision, AmeriCorps is revising the forms to cover all requests for health and religious accommodations. This information collection allows AmeriCorps to collect information in support of individuals' requests for religious and medical accommodations, made for sincerely held religious beliefs, practices, or observances. The forms associated with this system of records will facilitate the processing of requests for accommodations.
The latest form for Requests for Medical and Religious Reasonable Accommodation expires 2028-09-30 and is listed under ICR 202205-3045-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 1 Reasonable Accommodation Forms | Form and Instruction |
| 30-Day Notice for Reasonable Accommodation.pdf | Supplementary Document |
| 29 CFR 1605.2.pdf | Supplementary Document |
| 60-Day Notice for Reasonable Accommodation.pdf | Supplementary Document |
| Rehabilitation Act of 1973.pdf | Supplementary Document |
| Title VII Civil Rights Act of 1964.pdf | Supplementary Document |
 Supporting Statement A_RA_CLEAN 06-01-22.docx | Supporting Statement A |
 Reasonable Accommodation Forms |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202205-3045-002 | Revision of a currently approved collection | 2022-06-30 | ||
| 202111-3045-001 | New collection (Request for a new OMB Control Number) | 2021-11-29 | Approved with change |