Forms related to Reasonable Accommodation for Personal Health and Religious Information
New collection (Request for a new OMB Control Number)
No
Emergency
12/08/2021
11/29/2021
Requested
Previously Approved
6 Months From Approved
80
0
140
0
11,910
0
To meet the requirements of the Executive Orders and Task Force recommendations, AmeriCorps is seeking to create and maintain a Reasonable Accommodations system of records to allow for the collection and protection of information related to medical-based accommodation requests and accommodation requests made for sincerely held religious beliefs, practices, or observances. The forms associated with this system of records will facilitate the processing of requests for exemptions from the vaccine requirement.
See attached memo.
US Code:
42 USC 12501
Name of Law: National Community Service Act et. seq.
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.
Form 1 Reasonable Accommodation Forms
20211123 Emergency Justification Letter - KDahl signed.pdf
Reasonable Accommodation Forms