OMB control number

Requests for Medical and Religious Reasonable Accommodation

OMB 3045-0196 · CNCS.

OMB 3045-0196

AmeriCorps seeks to revise the current information collection, which was for requests for health and religious accommodations that were specific to seeking exemptions from the COVID-19 vaccination requirement, but with this revision, AmeriCorps is revising the forms to cover all requests for health and religious accommodations. This information collection allows AmeriCorps to collect information in support of individuals' requests for religious and medical accommodations, made for sincerely held religious beliefs, practices, or observances. The forms associated with this system of records will facilitate the processing of requests for accommodations.

The latest form for Requests for Medical and Religious Reasonable Accommodation expires 2028-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 Reasonable Accommodation Forms Form and Instruction
30-Day Notice for Reasonable Accommodation.pdf Supplementary Document
29 CFR 1605.2.pdf Supplementary Document
60-Day Notice for Reasonable Accommodation.pdf Supplementary Document
Rehabilitation Act of 1973.pdf Supplementary Document
Title VII Civil Rights Act of 1964.pdf Supplementary Document
Supporting Statement A_RA_CLEAN 06-01-22.docx Supporting Statement A
Reasonable Accommodation Forms Form and Instruction

All Historical Document Collections

202205-3045-002	Revision of a currently approved collection	2022-06-30
202111-3045-001 Approved with change	New collection (Request for a new OMB Control Number)	2021-11-29