Confirmation of Request for Reasonable Accommodation

ICR 201607-0704-004

OMB: 0704-0498

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2016-08-10
Supporting Statement A
2016-07-28
IC Document Collections
ICR Details
0704-0498 201607-0704-004
Historical Active 201305-0704-003
DOD/DODDEP
Confirmation of Request for Reasonable Accommodation
Extension without change of a currently approved collection   No
Regular
Approved without change 08/29/2016
Retrieve Notice of Action (NOA) 07/28/2016
  Inventory as of this Action Requested Previously Approved
08/31/2019 36 Months From Approved 08/31/2016
20 0 20
5 0 5
210 0 0

The information collection requirement is necessary to obtain and record requests for reasonable accommodation, with the intent to measure and ensure Agency compliance with 29 U.S.C. § 791, Employment of Individuals with Disabilities; E.O. 13164, Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommodation; EEO MD-715, EEO Reporting Requirements for Federal Agencies.

US Code: 29 USC 791 Name of Law: Employment of Individuals with Disabilities
   EO: EO 13164 Name/Subject of EO: Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommo
  
None

Not associated with rulemaking

  81 FR 33493 05/26/2016
81 FR 49215 07/27/2016
No

1
IC Title Form No. Form Name
Confirmation of Request for Reasonable Accommodation SD Form 827 Confirmation of Request for Reasonable Accommodation

  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 20 20 0 0 0 0
Annual Time Burden (Hours) 5 5 0 0 0 0
Annual Cost Burden (Dollars) 210 0 0 210 0 0
No
No

$8,006
No
No
No
No
No
Uncollected
Tyler Robinson 571 372-0403 tyler.f.robinson.ctr@mail.mil

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/28/2016


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