OMB control number

Disability Qualification Determination

OMB 3037-0012 · CPBSD.

OMB 3037-0012

The form will be used by the AbilityOne Program to determine eligibility as a qualified direct labor employee whose work will be counted as hours performed by a blind or significantly disabled individual as required by the JWOD Act (41 USC 85) U.S. AbilityOne Commission Compliance Policy 51.403.

The latest form for Disability Qualification Determination expires 2028-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Disability Qualification Determination Form
Redlined IEE.pdf Supplementary Document
Form 1 supporting statement - Inspected.docx Supporting Statement A
2024-24384.pdf Supplementary Document
INDIVIDUAL ELIGIBILITY EVALUATION (3).dotx Supplementary Document
Commission Policy 51.403 Determining Eligibility of Participating Employees signed-2Aug2024-a.pdf Supplementary Document
41 CFR 51-4.3 (up to date as of 10-09-2024) (1).pdf Supplementary Document
form 1 60-day notice 2023-25499.pdf Supplementary Document
Form 1 30-day Notice.docx Supplementary Document
Disability Qualification Determination Form
Individual Eligibility Evaluation Form Instruction

All Historical Document Collections

202410-3037-002	Reinstatement with change of a previously approved collection	2024-10-24
201204-3037-001 Approved without change	New collection (Request for a new OMB Control Number)	2012-09-17

OMB Details

Individual Eligibility Evaluation Form

Federal Enterprise Architecture: Economic Development - Business and Industry Development

Form 3037-0011

Individual Eligibility Eligibility

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.