View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Reasonable Accommodation related to Vaccination Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	COVID 19 Medical Accommodation Request	Request COVID 19 Medical Exemption writable.pdf	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	2	COVID-19 Religious Accommodation Request	Request COVID 19 Religious Exemption writable.pdf	www.americorps.gov	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title: CNCS-10-CEO-PHRI-Personal Health and Religious Information	FR Citation: 86 FR 64458

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	40	0	40	0	0	0
Annual IC Time Burden (Hours)	70	0	70	0	0	0
Annual IC Cost Burden (Dollars)	5,955	0	5,955	0	0	0

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.