Get Hra Reasonable Accommodation Request Form
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How to fill out the HRA Reasonable Accommodation Request Form online
This guide provides clear and supportive instructions on how to complete the HRA Reasonable Accommodation Request Form online. The purpose of the form is to request reasonable accommodations for individuals with disabilities, ensuring meaningful access to HRA programs and services.
Follow the steps to complete your accommodation request form online.
- Click ‘Get Form’ button to access the HRA Reasonable Accommodation Request Form and open it in your preferred online editor.
- Begin by entering your personal information in the designated fields, including your name, case number (if known), social security number (if known), telephone number, mailing address, center number (if known), and HRA program name (if known).
- Respond to the eligibility questions provided in the form. Indicate whether you have been evaluated by HRA’s WeCARE program, if an application for supportive housing has been submitted, if you receive federal disability benefits, and if you require home care services.
- Describe your medical or mental health condition in detail. Clearly state the reasonable accommodation you are requesting and explain why you need it. You may attach additional sheets or any relevant medical information to support your request.
- Provide your signature and date to confirm your submission. If applicable, include your authorized representative’s signature and their printed name.
- Once you have filled in all required fields, ensure that you save your changes. You can then download, print, or share the completed form as needed.
Take the important step of submitting your request by completing the HRA Reasonable Accommodation Request Form online today.
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.
Fill Hra Reasonable Accommodation Request Form
CALL: or VISIT: your center or HRA office. Turn this page over to complete the Reasonable Accommodation Request Form. âž¡. You can complete and submit HRA's Reasonable Accommodation Request (RAR) form or make your own written request. Form. It is very similar to HRA Form HRA-102a: Reasonable Accommodation. May HRHA may contact your healthcare provider to verify your disability and need for accommodation? â–¡ Yes - complete top of Accommodation Certification. â–¡No. Forward the completed form to the agency's Human Resources Associate (HRA).
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