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  • Reasonable Accommodation Form

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Reasonable Accommodation Request Form This form is to be completed by the head of household on behalf of the household member needing the accommodation and to be signed by both the head of household.

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How to fill out the Reasonable Accommodation Form online

This guide provides comprehensive instructions for completing the Reasonable Accommodation Form online. By following these steps, users can efficiently submit their accommodation requests to ensure their needs are met.

Follow the steps to successfully complete your Reasonable Accommodation Form online.

  1. Click ‘Get Form’ button to access the Reasonable Accommodation Form and open it in the designated editor.
  2. Begin by entering the name of the person who needs the accommodation in the specified field. This ensures that the request is clearly attributed to the correct individual.
  3. Next, fill in the head of household's name. This section requires the representative completing the form on behalf of the person needing accommodation.
  4. Provide the full address where you reside, including street number, street name, city, state, and zip code. This is important for any potential follow-up communication.
  5. Enter both the primary and alternate phone numbers to ensure that communication regarding the request can be easily established.
  6. In Section A, indicate whether you are the individual with a disability. If not, provide the name and relationship to the person who is. This clarifies the context of the request.
  7. In Section B, specify the reasonable accommodation you are requesting. You can check one or more boxes provided, and be as specific as possible about any changes to rules, policies, or procedures that will help.
  8. Use Section C to explain why the requested accommodation is necessary. Providing a clear rationale helps emphasize the need for the adjustments.
  9. Review Section D, which outlines the confidentiality of the information provided and how it will be used. Ensure you understand these terms before proceeding.
  10. Finally, both the head of household and the adult member requiring accommodation must sign and date the form where indicated. This confirms that all information is accurate and complete.
  11. After completing the form, save any changes made in the editor. You can then download, print, or share the completed form as needed before submitting it to the appropriate housing authority.

Take action now by filling out your Reasonable Accommodation Form online to ensure your needs are met.

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Requesting a Reasonable Accommodation To enable the IRS to keep accurate records regarding requests for accommodation, employees should follow up an oral request for accommodation by completing the Reasonable Accommodation Request, Form 13661.

What to Include in Your Reasonable Accommodation Letter Your name and position. ... The date. ... Information about your disability. ... A request for accommodation. ... Accommodation ideas. ... Medical information.

Examples of reasonable accommodations include providing interpreters, readers, or other personal assistance; modifying job duties; restructuring work sites; providing flexible work schedules or work sites (i.e. telework) and providing accessible technology or other workplace adaptive equipment.

Dear [Insert employer's name here]: I have been having medical issues that have affected my mood, sleep schedule, concentration, and focus. I would like to request accommodations so that I might be able to perform my job effectively before my performance starts to suffer.

What to Include in Your Reasonable Accommodation Letter Your name and position. ... The date. ... Information about your disability. ... A request for accommodation. ... Accommodation ideas. ... Medical information.

Examples of reasonable accommodations include making existing facilities accessible; job restructuring; part-time or modified work schedules; acquiring or modifying equipment; changing tests, training materials, or policies; and providing qualified readers or interpreters.

Dear [Employee name]: On [date], you informed [name and title] of your medical condition and requested a job accommodation to be able to perform your job functions. [Company Name] complies with the Americans with Disabilities Act (ADA), and we want to support you in continuing to perform your job duties.

Dear Mr./Ms. (Contact at Human Resources Department): I work at ________(Company Name) as a ________(Your Job Title) and have been in this position since ____ (Date). I am writing to request that you provide __________________(list accommodation needed here) as a reasonable accommodation under the ADA.

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Fill Reasonable Accommodation Form

JAN offers a number of sample forms. Employers may use these sample forms as a template for customizing forms or documents used during the interactive process. Use of this form is not mandatory in order to request an accommodation but will assist the OIG in completing review of the request. To request an accommodation based on a disability, an EPA employee or applicant can use the Request for Reasonable Accommodation Form (Appendix B). Use this sample form to start the documentation process for when employee requests a reasonable workplace accommodation under the ADA.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232