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OMB Control No: 0704-0498	ICR Reference No: 202512-0704-005
Status: Received in OIRA	Previous ICR Reference No: 202210-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Confirmation of Request for Reasonable Accommodation
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 12/29/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2026
Responses	20	20
Time Burden (Hours)	5	5
Cost Burden (Dollars)	216	216

Annual Cost to Federal Government: $8,200

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Joshua Kim 571 515-0234 joshua.t.kim4.civ@mail.mil

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