Information Collection Request

Disability Accommodation Request Form

ICR 202301-3045-006 · OMB 3045-0179 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3045-0179 can be found here:

Forms and Documents

Document Name	Status
Disability Accommodation Reimbursement Request Form Form and Instruction	Modified
NCSA.pdf Supplementary Document	2023-01-31
30-Day Disability Reimbursement_01-31-2023.pdf Supplementary Document	2023-01-31
60-Day Disability Reimbursement_87 FR 68139_11-14-2022.pdf Supplementary Document	2023-01-26
20230103 Days of Services Instructions SSA_UPDATED.docx Supporting Statement A	2023-01-31

IC Document Collections

IC ID	Document Title	Status
221228	Disability Accommodation Reimbursement Request Form Form and Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	CNCS
OMB Control No	3045-0179
Type of Information Collection	Extension without change of a currently approved collection
Previous ICR Reference No	202006-3045-003
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31