Voluntary Self-Identification of Disability
	
		Form CC-305
		Page 1 of 1
	
	
	
		OMB Control Number 1250-0005
		Expires 04/30/2026
	
	
	
	 
	
		
Why are you being asked to complete this form?
		We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
	
	 	
How do you know if you have a disability?
		A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
	
	
	
		
Please check one of the boxes below:
	
		 
		PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.