Information Collection

Request for Reasonable Accommodation

IC 197899 under ICR 201305-0651-001 · OMB 0651-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0012 can be found here:

Documents and Forms

Document Name Document Type
Form PTO 158RA Request for Reasonable Accommodation Form and Instruction
PTO 158RA Request for Reasonable Accommodation Aug_2011_PTO158RA_Draft_Form_0651-0012.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Reasonable Accommodation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 11.7

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PTO 158RA	Request for Reasonable Accommodation	Aug_2011_PTO158RA_Draft_Form_0651-0012.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	31	31

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.