SUPPORTING STATEMENT - PART A
Confirmation of Request for Reasonable Accommodation– 0704-0498
1. Need for the Information Collection
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.
2. Use of the Information
The information collected will be used by the Reasonable Accommodations Program Manager (RAPM) and the Equal Employment Office Program to track requests for reasonable accommodation to determine whether the agency has implemented timely and effective measures to meet each individual’s request. Ensures that all contracts for the use of facilities, such as leased buildings and hotels for training programs or conferences, reflect the obligation that such facilities be accessible to all participants including those with disabilities. One form, “Confirmation of Request for Reasonable Accommodation” (SD FORM 827), will be used to collect information.
3. Use of Information Technology
100% of the information is collected electronically. Employees and applicants will be able to prepare these forms via a fillable PDF and submit the final product electronically through use of the electronic mail system. This will reduce the use of paper and shorten the time in which a respondent will need to complete the form and submit it for processing.
4. Non-duplication
The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.
5. Burden on Small Businesses
This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.
6. Less Frequent Collection
Pursuant to E.O. 13164, EEO MD-715, and 29 U.S.C. § 79, the agency has a requirement to report their efforts towards reasonable accommodation on an annual basis.
7. Paperwork Reduction Act Guidelines
This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).
8. Consultation and Public Comments
Part A: PUBLIC NOTICE
A 60-Day Federal Register Notice (FRN) for the collection published on Tuesday, September 23, 2025. The 60-Day FRN citation is 90 FR 45753.
No comments were received during the 60-Day Comment Period.
A 30-Day Federal Register Notice for the collection published on Monday, December 29, 2025. The 30-Day FRN citation is 90 FR 60690.
Part B: CONSULTATION
No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.
9. Gifts or Payment
No payments or gifts are being offered to respondents as an incentive to participate in the collection.
10. Confidentiality
A
Privacy Act Statement is located at the bottom of the SD Form
827.
All medical or disability-related information is
collected and maintained by the agency’s Reasonable
Accommodation Program Manager and kept confidential in accordance
with the U.S. Equal Employment Opportunity Commission (EEOC)
regulations. Under 29 C.F.R. § 1630.14(b)(1), such information
must be collected, maintained, kept in separate files, and treated as
confidential medical records.
The SORN covering this collection of information is DWHS P49, “Reasonable Accommodation Program Records” was rescinded and a rule established to exempt this system of records from certain provisions of the Privacy Act. https://www.federalregister.gov/documents/2021/07/22/2021-15600/privacy-act-of-1974-implementation
A Privacy Impact Assessment (PIA) is included in the package.
The records disposition is under GRS 1, Item 24.
202-43.9 Reasonable Accommodation Request Records 202-43.9.1. General Request Records Agency-wide and departmental procedures for receiving, processing, and appealing requests for reasonable accommodation by employees and applicants. Files may include, but are not limited to: instructions, directives, notices, forms, timetables, guidelines for requesting, processing and approving requests for appealing decisions for reasonable accommodation. Also included are records notifying the Equal Employment Opportunity Commission (EEOC), the agency's collective bargaining representative(s) and the agency’s EEO office of the agency's reasonable accommodation request and processing procedures as well as modifications to established procedures. Disposition: Destroy/Delete 3 years after superseded or when no longer needed for reference, whichever is later. GRS 1, Item 24a.
202-43.9.2. Employee Case Files- Individual employee files that are created, received, and maintained by EEO reasonable accommodation or diversity/disability program or employee relations coordinators, immediate supervisors, Computer/Electronic Accommodation Program (CAP) administrator, or HR specialists containing records of requests for reasonable accommodation and/or assistive technology devises and services through the agency or CAP that have been requested for or by an employee. This series also includes, but is not limited to request approvals and denials, notice of procedures for informal dispute resolution or appeal processes, forms, correspondence, e-mails; records of oral conversations, medical documentation, and notes. [Note: These records are neither part of an employee's Official Personnel File (OPF) nor part of a supervisor's unofficial personnel file. Disposition: Destroy/Delete 3 years after employee separation from the agency or all appeals are concluded, whichever is later. GRS, Item 24b.
11. Sensitive Questions
The form will ask the respondent to provide a description of the reasonable accommodation being requested, and the reason for their request. In so doing, the respondent is being asked specific detailed information about a medical condition that may or may not be sensitive in nature. The respondent will be told that the information collected will not result in any adverse determinations about his or her rights, privileges, or benefits under any Federal program, with the exception of making a determination on whether the employee is eligible to receive a reasonable accommodation.
12. Respondent Burden and its Labor Costs
Part A: ESTIMATION OF RESPONDENT BURDEN
Collection Instrument
SD Form 827
Number of Respondents: 20
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 20
Response Time: 15 minutes
Respondent Burden Hours: 5 hours
Total Submission Burden
Total Number of Respondents: 20
Total Number of Annual Responses: 20
Total Respondent Burden Hours: 5 hours
Part B: LABOR COST OF RESPONDENT BURDEN
Collection Instrument
SD Form 827
Number of Total Annual Responses: 20
Response Time: 15 minutes
Respondent Hourly Wage: $43.10
Labor Burden per Response: $10.78
Total Labor Burden: $215.50
Overall Labor Burden
Total Number of Annual Responses: 20
Total Labor Burden: $215.50
The Respondent hourly wage was determined by using the Federalpay.org GS 12 step 5 (https://www.federalpay.org/gs/2025/GS-12)
13. Respondent Costs Other Than Burden Hour Costs
There are no annualized costs to respondents other than the labor burden costs addressed in Section 12 of this document to complete this collection.
14. Cost to the Federal Government
Part A: LABOR COST TO THE FEDERAL GOVERNMENT
Collection Instrument
SD Form 827
Number of Total Annual Responses: 20
Processing Time per Response: 8 hours
Hourly Wage of Worker Processing Responses : $51.25
Cost to Process Each Response: $410
Total Cost to Process Responses: $8,200
Overall Labor Burden to the Federal Government
Total Number of Annual Responses: 20
Total Labor Burden: $8,200
Part B: OPERATIONAL AND MAINTENANCE COSTS
Cost Categories
Equipment: $0
Printing: $0
Postage: $0
Software Purchases: $0
Licensing Costs: $0
Other: $0
Total Operational and Maintenance Cost: $0
Part C: TOTAL COST TO THE FEDERAL GOVERNMENT
Total Labor Cost to the Federal Government: $8,200
Total Operational and Maintenance Costs: $0
Total Cost to the Federal Government: $8,200
15. Reasons for Change in Burden
There has been no change in burden since the last approval.
16. Publication of Results
The results of this information collection will not be published.
17. Non-Display of OMB Expiration Date
We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.
18. Exceptions to “Certification for Paperwork Reduction Submissions”
We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kaitlin Chiarelli |
| File Modified | 0000-00-00 |
| File Created | 2025-12-30 |