Get Nvcc 105–194 2021-2026

Completing the NVCC 105–194 form is an essential step in facilitating accommodations for individuals with disabilities in the workplace. This guide will provide you with clear and supportive instructions to help you fill out this form accurately and efficiently.

Follow the steps to properly complete the NVCC 105–194 form online.

1. Click the ‘Get Form’ button to access the NVCC 105–194 document and open it in your preferred editor.
2. Begin by filling in the employee's name at the designated field. Ensure that the information matches exactly what is on official documents.
3. Sign the form where indicated to confirm the accuracy of the information and the request.
4. Enter the date after signing the form. This is important for processing timelines.
5. The medical professional should provide their name, title/specialty, work phone, and address in the relevant fields to ensure communication is clear.
6. Instruct the medical professional to indicate if the employee currently has a physical or mental condition by selecting 'yes' or 'no.' If 'yes,' they must specify the nature and severity of the condition.
7. Ask if the condition is permanent. The medical professional should provide information if the condition is not permanent, including the expected duration.
8. Determine if the condition substantially limits a major life activity and specify which activities are affected.
9. Check if the condition limits any major bodily functions and describe what functions are impacted.
10. Detail how the condition affects the employee's ability to perform essential job functions. This requires referencing the Employee Work Profile or Faculty Work Plan.
11. List any accommodations that may help the employee perform their job functions, along with how long these accommodations will be needed.
12. If applicable, include any additional documentation that supports the request for accommodation.
13. Once all sections are completed, return the form to the employee for submission.

Complete the NVCC 105–194 form online to ensure the processing of accommodation requests.