To meet the assessment requirements of the No Child Left Behind Act (NCLB) and the Individuals with Disabilities Education Act (IDEA), states must ensure the inclusion of students with disabilities, as well as provide for the appropriate use of assessment accommodations. Accommodations have been defined in a number of ways. In the Council of Chief State School Officers (CCSSO) Accommodations Manual, accommodations were defined as "practices and procedures in the areas of presentation, response, setting, and timing/scheduling that provide equitable access during instruction and assessments for students with disabilities" (Thompson, Morse, Sharpe, & Hall, 2005, p. 14). More recently, accommodations have been distinguished from modifications by focusing on the validity of assessment results when the changes in testing materials or procedures are used. When assessment accommodations are used appropriately, students are best able to demonstrate their learning and schools are able to account accurately for what students do and do not know. Accommodations are addressed in NCLB peer reviews through Sections 4 and 6 of the Peer Review Guidance. The authors conducted a thematic analysis of peer reviewers' comments for 50 states. Their goal was to identify common issues and examples of the types of evidence considered acceptable and not acceptable by peer reviewers. Four themes emerged in their analysis of peer review comments on accommodations in states' submissions for review of their assessment systems: (1) Selection of accommodations; (2) Agreement of assessment accommodations with instructional accommodations; (3) Monitoring accommodations availability and use; and (4) Accommodations use provides valid inferences and meaningful scores about students' knowledge and skills. The process of identifying themes revealed that pulling information from peer reviewers' comments provides findings that should be of interest to the states and test developers, and to anyone concerned about the quality of accommodated assessments. Many useful recommendations evolve from the comments. At the same time, the information has several limitations that may be due to the different review panels and reviewers' attempts to deal with states in a positive manner. Appendix includes: Peer Review Sections. (Contains 33 tables and 5 figures.) [This study was commissioned by the Accommodations Monitoring Study Group of the Assessing Special Education Students (ASES) State Collaborative on Assessment and Student Standards (SCASS).]