OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information

ICR 201004-2900-003 · OMB 2900-0767 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 0857A Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information Form New Available
0857a justification.doc Supporting Statement A Uploaded 2010-07-13 Available
0857 EEO comments.tif Supplementary Document Uploaded 2010-04-20 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
192637 Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information Form New
ICR Details
2900-0767 201004-2900-003
Historical Active
VA
Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information
Existing collection in use without an OMB Control Number   No
Regular
Approved without change 03/21/2011
Retrieve Notice of Action (NOA) 07/13/2010
Approved; VA shall seek and must receive a valid OMB control number for collections of information subject to the Paperwork Reduction Act.
  Inventory as of this Action Requested Previously Approved
03/31/2014 36 Months From Approved
35 0 0
18 0 0
0 0 0
Reasonable accommodation for applicants will be used to assess whether requesters may qualify for an accommodation during the application or interview process.
PL: Pub.L. 110 - 325 1 Name of Law: ADA Amendments Act of 2008
   PL: Pub.L. 93 - 112 Sections, 501 and 505 Name of Law: The Rehabilitation Act of 1973
  
None
Not associated with rulemaking
  75 FR 27 02/10/2010
75 FR 74 04/19/2010
Yes
  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 35 0 0 35 0 0
Annual Time Burden (Hours) 18 0 0 18 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.
No
No
No
Uncollected
No
Uncollected
Denise McLamb 202-565-8374 [email protected]
  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.
07/13/2010