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Get USDA AD-1163 2002-2024

_______________ Employee Only: Occupational Series: ___________ Grade: _______ Applicant or Employee E-mail Address: ____________________________________________ Date of Request: _____________________________________ Employee’s Agency: _________________________________ 1. Accommodation Requested (be as specific as possible) 2. Reason for Request 3. If accommodation is time sensitive, please explain: This request form shall be given to your immediate supervisor or Mission Are.

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