Accommodation Request Form

Information Collection Submission for MSPB Reasonable Accommodation Requests

Documents and Forms

Document Name Document Type
Accommodation Request Form Form and Instruction
Accommodation Request Form RA Form (May 2025) - 508.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Accommodation Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Accommodation Request Form	RA Form (May 2025) - 508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: MSPB - 3 Reasonable Accommodation	FR Citation: 86 FR 73001

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	758	758

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.