Reasonable Accommodation Requests, FCC Forms 5626 and 5627

OMB 3060-1246

This information, completed on FCC Form 5626 and FCC Form 5637 will be used by the OWD to process, track, and maintain the confidentiality of reasonable accommodation requests.

The latest form for Reasonable Accommodation Requests, FCC Forms 5626 and 5627 expires 2023-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form FCC Form 5627 Individuals or Households Form
Form FCC Form 5626 Federal Government Form
3060-1246_final version_June 2023 (1).docx Supporting Statement A
Individuals or Households Form
Federal Government Form

All Historical Document Collections

202306-3060-003 Approved without change	Extension without change of a currently approved collection	2023-06-22
202006-3060-010 Approved without change	Extension without change of a currently approved collection	2020-07-09
201708-3060-012 Approved without change	New collection (Request for a new OMB Control Number)	2017-08-18

OMB Details

Federal Government

Federal Enterprise Architecture: General Government - Central Fiscal Operations

Form FCC Form 5626

Reasonable Accommodation Form with Questionnaire

Fillable Fileable Signable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.