OCCUPATIONAL SAFETY AND HEALTH                               OSHRC OFAS 1723-2

                  REVIEW COMMISSION                                               June 20, 2002




I.      Policy


This directive sets forth Review Commission’s policy to fully comply with the reasonable accommodation requirements of the Rehabilitation Act of 1973. The Review Commission is committed to providing reasonable accommodations to qualified employees and applicants for employment, unless to do so would cause undue hardship, in order to assure that individuals with disabilities enjoy full access to equal employment opportunity at the Review Commission. The Review Commission will process requests and, where appropriate, provide accommodation promptly, fairly, and efficiently.


II.    Authority


              29 U.S.C. § 791

              42 U.S.C. § 12101 et seq.

              29 C.F.R. Part 1630

              Executive Order 13164 (65 Federal Register 46565) Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommodation

              Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act www.eeoc.gov


III.   Definition of Key Terms


         A.   Disability

                Disability means, with respect to an individual –

                     a physical or mental impairment that substantially limits one or more of the major life activities of the individual,

                     a record of such an impairment, or

                     is regarded as having such an impairment.     

         B.   Qualified Individual with a Disability


An individual with a disability is qualified if he/she:


                     satisfies the requisite skill, experience, education, and other job-related requirements of the position, and


                     can perform the essential functions of the position, with or without reasonable accommodation.


         C.   Essential Functions


Those job duties that are so fundamental to a position that the job cannot be done without performing them. A function can be "essential" if, among other things:


                     the position exists specifically to perform that function

                     there are a limited number of other employees who could perform the function

                     the function is specialized and the individual is hired based on his/her ability to perform it


The determination of the essential functions of a position must be done on a case-by-case basis so that it reflects the job as actually performed, and not simply the components of a generic position description.

         D.   Reasonable Accommodation


Any change in the work environment or in the way things are customarily done that would enable a qualified individual with a disability to enjoy equal employment opportunities.


         E.    Undue Hardship


An undue hardship to the operations of the agency occurs when a specific accommodation would result in significant difficulty or expense, or would fundamentally alter the nature of the Review Commission's operations. EEOC will review agency determinations of undue hardship on a case-by-case basis, considering factors such as the nature and cost of the accommodation needed and the impact of the accommodation on the operations of the agency.


         F.    Reassignment


A reassignment is a form of reasonable accommodation that, absent undue hardship, may be provided to employees (not applicants) who, because of a disability, can no longer perform the essential functions of their job, with or without reasonable accommodation. The agency must determine that no other reasonable accommodation would permit the employee to perform essential functions of the current position. Reassignments are made only to vacant positions and to employees who are qualified for the new position. If the employee is qualified for the position, he/she will be reassigned to the job and will not have to compete for it. In considering whether there are positions available for reassignment, the Executive Director will consider vacant positions or positions that may become vacant within 60 days. The Executive Director will consult with the appropriate supervisors and the employee, as necessary, on such matters as: whether there are limits on the search the employee would like the agency to conduct; whether the employee is qualified for a particular job; or whether the employee would need a reasonable accommodation to perform the essential functions of a new position.


Reassignment is a “last resort” accommodation and will only be considered if no other accommodations are available to enable the individual to perform his or her current job, or if the only effective accommodation would cause undue hardship to the operations of the agency.

IV.  Requests for Reasonable Accommodation


A request for reasonable accommodation is a statement that an individual needs an adjustment or change at work, in the application process, or in a benefit or privilege of employment for a reason related to a medical condition. A request does not have to use any special words, such as "reasonable accommodation," "disability," or "Rehabilitation Act."


An individual can make a request for reasonable accommodation at anytime, even if he/she has not previously disclosed the existence of a disability. An employee may request a reasonable accommodation orally or in writing from any agency official, e.g., the supervisor, the office head, or the Executive Director (Disability Program Manager and EEO Director). An applicant may request a reasonable accommodation orally or in writing from any agency employee they come in contact with in connection with the application process. Review Commission employees will direct the applicants to the Personnel Management Specialist.


A family member, health professional, or other representative of the employee or the applicant may request a reasonable accommodation on behalf of the employee or applicant. The request should go to the same person to whom the employee or applicant would make the request. When a request for accommodation is made by a third party, the decision maker should, if possible, confirm, with the applicant or the employee, that she/he, in fact, wants a reasonable accommodation.

 Processing the Request 


The Review Commission will begin processing the request as soon as it is received. A written request is not a requirement to begin the process. However, to enable the Review Commission to complete the reasonable accommodation process and keep accurate records regarding requests for accommodation, the applicant or employee will be required to confirm the request in writing.


A written request must include the information in the “Request for Reasonable Accommodation” form. (Attachment 1) Employees may submit the request form or send the form as an attachment to an e-mail message. If you need assistance with this requirement, contact the Personnel Management Specialist. A written request is not required if an employee needs the same accommodation on a repeated basis. Appropriate

notice must be given each time the accommodation is needed (e.g., the assistance of sign language interpreters or readers).


Supervisors, office heads and the Executive Director, or their designees are authorized to decide requests for reasonable accommodation, as outlined below. Any Review Commission person who receives a request will forward the request as soon as possible, but in no more than two days, to the appropriate decision maker - supervisor, office head or the Executive Director. If the request is forwarded to the Executive Director, a copy of the request will be sent to the supervisor of the employee. Whoever is serving in an acting capacity for the decision maker during his/her absence, will make the decision. The time frames for providing reasonable accommodation will not be suspended or extended because of the unavailability of a decision maker.


Authorities of Supervisors and Office Heads


The supervisor or office head may decide requests concerning:


              Making minor adjustments to an employee’s work area

              Requests from employees who sit in open areas for privacy to perform tests (e.g., respiratory function, blood sugar levels)

              Requests for distribution of meeting materials in advance to accommodate employees with learning disabilities or dyslexia

              Requests for materials in alternative formats (e.g., large print)

              Requests from regional office staff for accessible parking

              Requests for a reader or sign language interpreter, or other staff assistant to enable employees to perform their job functions (Working in coordination with the Office of Financial and Administrative Services to provide a contract) NOTE: Appendix A provides guidance on utilizing sign language interpreters.

              Any other accommodations that do not require expenditure of funds, personnel actions, or involve other offices in the Review Commission


          Authorities of Executive Director


The Executive Director will serve as the Review Commission’s Disability Program Manager. The Executive Director will handle the following:


              Requests for adaptive equipment, specially designed furniture, or the removal

               of an architectural barrier(s), including reconfigured work spaces

              Requests by national office staff for accessible parking

              Requests for reassignment to another job or changes in an employee’s tour of duty

              Any other accommodations that require expenditure of funds, personnel actions, or involve other offices in the Review Commission


V.     Making a Decision on a Reasonable Accommodation Request


The Review Commission’s policy is to fully comply with the requirements of Title I of the ADA and EEOC guidelines when making decisions on requests for reasonable accommodation. The Review Commission will provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, except when such accommodation would cause an undue hardship. Specifically, the Review Commission will provide reasonable accommodation:


              when an applicant with a disability needs an accommodation in order to be considered for a job

              when an employee with a disability needs an accommodation to enable him or her to perform the essential functions of the job or to gain access to the workplace

              when an employee with a disability needs an accommodation to enjoy the equal benefits and privileges of employment

 Factors to Consider


An individual has a disability if he or she (1) has physical or mental impairment that substantially limits one or more of the major life activities of the individual, (2) has a record of such an impairment, or (3) is regarded as having such an impairment. A person with a disability is qualified for a job if he/she can perform the essential functions of that job with or without the reasonable accommodation.


Substantially limits means: (1) unable to perform a major life activity that the average person in the general population can perform or (2) significantly restricted as to the condition, manner or duration under which an individual can perform a particular major life activity as compared to the condition, manner, or duration under which the average person in the general population can perform that same major life activity. 29 C.F.R. §1630.2(j)


The following factors should be considered in determining whether an individual is substantially limited in a major life activity:


              the nature and severity of the impairment

              the duration or expected duration of the impairment; and

              the permanent or long term impact, or the expected permanent or long term impact of or resulting from the impairment




Communication is a priority throughout the entire process. The individual requesting accommodation and the decision maker share the responsibility to maintain on-going communication. This is particularly important:


              where the specific limitation, problem, or barrier is unclear

              where an effective accommodation is not obvious

              where the parties are considering different possible reasonable accommodations


For more guidance on the legal standards governing reasonable accommodation, decision makers should review EEOC guidance contained on its website at www.eeoc.gov. The decision maker (managers and supervisors) and anyone responsible for processing an accommodation request may consult with appropriate resources for assistance before making a decision. (See Appendix B)


Handling Reasonable Accommodation Requests


         A.   What if the disability and/or need for reasonable accommodation is obvious and no medical information is required?


After considering the factors mentioned above, the decision maker may use the resources listed in Appendix B to determine whether the requested accommodation or an alternate accommodation is appropriate. In addition, the Review Commission currently has a partnership with the Computer/Electronic Accommodations Program (CAP) in the Department of Defense to provide assistive technology, devices, and services. The decision maker may request assistance from the CAP (see Section IX below) and, in the case of a supervisor or an office head, consult with the Executive Director to assess the appropriateness of the request for reasonable accommodation.


         B.   What if the disability and/or need for reasonable accommodation is not obvious or otherwise already known?


The individual must provide appropriate documentation about the disability and his or her functional limitations. Decision makers should follow the steps outlined below:


                     The supervisor or the office head, as appropriate, will make a request to the Executive Director to obtain such information.

                     The Executive Director will make a determination as to whether medical documentation is necessary. If it is, he/she will request the necessary medical information. If it is not necessary, he/she will return the request for accommodation to complete the processing.


                     If medical information is necessary, all requests for medical information will follow the requirements set forth in the Equal Employment Opportunity Commission’s (EEOC) Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees Under the Americans with Disabilities Act (available on EEOC’s website).

                     The Executive Director will seek information or documentation about the disability and/or functional limitations from the individual, and/or ask the

individual to obtain such information from an appropriate professional, such as a doctor, social worker, or rehabilitation counselor.


         C.   What types of medical information or documentation may an agency request in connection with a request for reasonable accommodation?


                     A description of the nature, severity, and duration of the individual’s impairment

                     The activity or activities that the impairment limits

                     The extent to which the impairment limits the individual’s ability to perform the activity or activities

                     Why the individual requires reasonable accommodation or the particular reasonable accommodation requested, as well as how the reasonable accommodation will assist the individual to apply for a job, perform the essential functions of the job, or enjoy a benefit of the workplace


         D.   What happens once the decision maker receives the medical documentation?


The Executive Director will evaluate it, in consultation with a physician or other health professional chosen by the Review Commission, if necessary.


                     If the information provided is insufficient to determine whether an accommodation is appropriate, the Executive Director may ask for further information

                     First, however, he/she will explain to the individual seeking the accommodation, why the information which has been provided is insufficient, what additional information is needed, and why it is necessary to make a determination

                     If the employee does not provide the necessary documentation, his/her request for reasonable accommodation may be denied


         E.    May the agency request that its physician examine an individual who has asked for a reasonable accommodation?


Yes. The Executive Director may request that the individual be examined by a physician chosen by the Review Commission only if the individual has failed to provide sufficient documents from his/her own health care or other appropriate professional to substantiate the existence of a disability and the need for reasonable accommodation. Any such medical examination must be limited to determining the existence of a disability and/or the functional limitations that require a reasonable accommodation. The agency will pay for all expenses of the medical examination.


Confidentiality Requirements


Medical information must be kept confidential. This means that all medical information, including information about functional limitations and reasonable accommodation needs, must be kept in files separate from the individual's personnel file.


The Executive Director will maintain custody of all records obtained or created during the processing of a request for reasonable accommodation, including medical records, and will respond to all requests for disclosure of the records. All records will be maintained in accordance with the Privacy Act and the requirements of 29 C.F.R. §1611.


All requests for and provisions of reasonable accommodation and medical information obtained for reasonable accommodation requests must be kept confidential. Such information can only be disclosed as follows:


              Supervisors and managers who need to know may be told about necessary restrictions on the work or duties of the employee and about the necessary accommodation(s)

              First aid and safety personnel may be informed, when appropriate, if the disability might require emergency treatment

              Government officials may be given information necessary to investigate the agency's compliance with the Rehabilitation Act

              The information may in certain circumstances be disclosed to workers' compensation offices or insurance carriers

              EEO officials may be given the information to maintain records and evaluate and report on the agency’s performance in processing reasonable accommodation requests


Whenever medical information is disclosed, the individual disclosing the information must inform the recipients of the information about the confidentiality requirements that attach to it.


Denial of Requests


The employee or applicant for employment will be notified orally or in writing that the request has been approved and the accommodation will be provided. In case of a denial, the Denial of Request for Reasonable Accommodation form (Attachment 2) will be used to notify the individual. Any denial notice must be in writing and must include:


              specific reasons for the denial in plain language

              the reasons for offering a more effective alternative accommodation

              the right of the individual to file an EEO complaint and/or to pursue MSPB procedures

              any other information required on the form


Some reasons that a request for reasonable accommodation may be denied include the following:


              The requested accommodation would not be effective.

              Providing the requested accommodation would result in undue hardship on the operations of the agency (before reaching this determination, the decision maker must have explored whether other effective accommodations exist which would not impose undue hardship).

              Medical documentation is inadequate.

              The accommodation requested would require the removal of an essential function of the position or lowering a performance standard.


VI.   Time Frames for Processing Requests and Providing Reasonable Accommodations

         A.   What is the time frame for processing reasonable accommodation requests?


The Review Commission will process requests and provide accommodation promptly, and generally, no later than 10 business days after receiving all information needed to render a decision fairly, and efficiently.



Maximum Number of Business Days

Person receiving the request forwards to the decision maker (the supervisor, office head, Executive Director, as appropriate)


Supervisor or office head responds to the request for reasonable accommodation (if authorized) or forwards the request to the Executive Director


Executive Director decides, if no further information is required, or requests additional information of the employee



Executive Director decides after receiving all necessary information


Executive Director initiates the implementation of the decision



         B.   Under what circumstances will this time frame be expedited?


The timeframe can be expedited when the accommodation needs to be immediate. Examples of this include circumstances when:


                     an applicant needs assistance in applying for a job

                     an employee needs an accommodation to attend a meeting

                     when the employee has a recurring or predictable need for accommodation (e.g., an accommodation may be made without an individual’s request)


C. Under what circumstances can these time frames be extended?


When factors exist that could not reasonably have been anticipated or avoided in advance of the request for accommodation. Extensions based on extenuating circumstances should be limited to circumstances where they are strictly necessary. Some examples of extenuating circumstances are:


                     There is an outstanding request for medical information

                     The purchase of furniture or equipment may delay the implementation

                     Unavailability of furniture or equipment

                     The employee needs to work with the equipment on a trial basis before it is purchased

                     The accommodation involves the removal of architectural barriers

                     The service required is not immediately available


         D.   What happens when there are extenuating circumstances?


                1.    The Executive Director (or the supervisor or office head as appropriate) will notify the individual, in writing, of the reason for the delay, and the approximate date on which a decision, or provision of the reasonable accommodation, is expected.

                2.    The Executive Director (or the supervisor or office head as appropriate) will determine if temporary measures are appropriate.

                3.    The Executive Director (or the supervisor or office head as appropriate) will communicate any further developments or changes promptly to the individual.


         E.    Can temporary measures be used?


Yes. The Executive Director (or the supervisor or office head as appropriate) will notify the individual in writing that the accommodation is being provided on a temporary basis pending a decision on the accommodation request.


VII.  Request for Reconsideration


In case of denial of the request for reasonable accommodation, the individual may present additional or new information to the original decision maker, (the Executive Director, the supervisor, or office head) in support of his/her request. The Executive Director (or the supervisor or office head as appropriate) will respond to the request for reconsideration within three business days.


If the decision maker was the supervisor, and he/she does not reverse the decision, the individual can ask the office head to do so. The office head will respond to this request within three business days.


If the decision maker was the office head, and he/she does not reverse the decision, the individual can ask the Executive Director who will respond to this request within ten business days.


If the decision maker was the Executive Director, and he/she does not reverse the decision, the individual can ask the Chairman to do so. The Chairman will respond to this request within ten business days.

VIII. Relation of Procedures to Statutory Claims


         A.   Does pursuing any of the informal dispute resolution procedures identified above effect the time limits for initiating statutory claims?



B. What is the relation of these procedures to statutory claims?


This policy is in addition to statutory protections for persons with disabilities and the remedies they provide for the denial of requests for reasonable accommodation.


         C.   What must I do to pursue statutory remedies for the denial of reasonable accommodation?


For an EEO complaint, you must contact an EEO counselor within 45 days from the date of receipt of the written notice of denial.


For an appeal able adverse action as defined in 5 C.F.R. 1201.3, you must initiate an appeal to the Merit Systems Protection Board within 30 days of the appeal able adverse action.


IX.   Additional Information


         A.   What type of assistive technology does Computer/Electronics Accommodation Program (CAP) offer?


CAP offers a wide variety of assistive technology for people with hearing, visual, dexterity, cognitive, or communication disabilities. Some of the assistive technology includes: alternative key boards, pointing devices, print enlargers, screen readers, speech recognition software, and teletypewriters.


         B.   Is CAP available for Review Commission employees?


You can contact your supervisor, the Office of Financial and Administrative Services, or the Executive Director on the availability of using CAP.


         C.   How can I find out which assistive technology device is best for me?


If the CAP program is available, you can request a needs-assessment. This assessment is an evaluation of your needs so that the equipment that is best suited to your situation can be identified. You can also visit a local store to evaluate the product on your own.


         D.   How is the needs-assessment performed?


CAP maintains the CAP Technology Evaluation Center (CAPTEC), at the Pentagon, where employees and/or their supervisors in the national office can make an appointment to have an assessment/evaluation done.


For regional office employees, CAP can do an over-the-telephone assessment/evaluation.


         E.    What should I do when I know which device is appropriate for me?


Following the completion of the needs assessment/evaluation, or obtaining the specific product information for what you know that you need, you must complete a CAP Request Form (Attachment 3).


         F.    Do I need to submit a note from a physician?


Sometimes. CAP may require “additional information (see CAP Form Page 1 #3). Medical documentation may be required to support the need of an accommodation under the Rehabilitation Act. See Section V, Question C for more on medical information to be provided.


         G.   What happens after I complete the CAP Request Form?


                     Your supervisor signs the form and sends it to the Executive Director.

                     The Executive Director sends the form to the CAP office.

                     If CAP finds that the accommodation is appropriate, the equipment is ordered within 7 to 10 days and shipped directly to you.


         H.   Whom can I contact for more information about the Review Commission’s procedures?


The Executive Director at 202-606-5380.


         I.     How can I obtain a copy of these procedures?


These procedures will be distributed to all employees upon issuance. They also will be posted on the Review Commission's intranet site and given to all new employees as part of their orientation. Copies also will be available in OFAS.


         J.    Are these procedures available in alternative formats?


Yes. The Executive Director will make these procedures available in alternative formats upon request.


X.     Information Tracking and Reporting


The decision maker will complete the "Request for Reasonable Accommodation Reporting Form" (Attachment 4) and submit it to the Executive Director within 10 business days of a decision. Copies of all information, including medical information, as part of processing the request should be attached to the form. The data on these forms are used to track information and to assess the Review Commission's reasonable accommodation program and to make recommendations for improvement of the Review Commission's reasonable accommodation policies and procedures.


The Executive Director will maintain these records for five years.



This directive supersedes OFAS 1723-2, dated September 5, 2001.




PATRICIA A. RANDLE                                                       THOMASINA V. ROGERS

EXECUTIVE DIRECTOR                                                    CHAIRMAN


Utilizing Sign Language Interpreters

1. SCHEDULING INTERPRETER SERVICES. The individual or office scheduling a meeting or event which will require interpreting services (staff meeting, training, office function, etc.) is responsible for directing the request, via e-mail, to the Executive Director.

Under normal circumstances, advance scheduling of two weeks is required. However, arrangements can be made in a shorter timeframe when necessary. Failure by the office scheduling the meeting to schedule interpreting services well in advance may result in the necessity to reschedule meetings until interpreter services are available.

An employee who knows sign language or who is taking a sign language class and has not been certified, is not an acceptable substitute for a contract interpreter.

2. WORK EVENTS OUTSIDE THE WORKPLACE. The Review Commission will provide an interpreter for an employee who is deaf or hard of hearing who, as part of his/her job, attends a meeting or event outside of the workplace. If he/she attends a conference or training program sponsored by an outside organization, the sponsoring organization is principally responsible for providing interpreters. If the sponsoring agency fails to do so, the Review Commission will provide for a contract interpreter.

3. OFFICE SOCIAL FUNCTIONS AND SPECIAL EVENTS. The Review Commission will contract for interpreting services for office or agency social functions or special events which are scheduled during official government time and which might be attended by employees who are deaf or hard of hearing.

4. INTERPRETING PHONE CALLS. Employees who are deaf or hard of hearing should use the telecommunication relay service to serve their telephone needs. If an interpreter is needed to interpret business-related phone calls, the employee should request that arrangements are made for a contract interpreter.


Selected Reasonable Accommodation Resources


1.   U.S. Equal Employment Opportunity Commission

1-800-669-3362 (Voice) 1-800-800-3302 (TT)


        The EEOC's Publication Center has many free documents on the Title I employment provisions of the ADA, including both the statute, 42 U.S.C. 12101 et seq. (1994), and the regulations, 29 C.F.R. 1630 (1997).

        In addition, the EEOC has published a great deal of basic information about reasonable accommodation and undue hardship.

        The two main sources of interpretive information are:

            The Interpretive Guidance accompanying the Title I regulations (also known as the "Appendix" to the regulations), 29 C.F.R. pt. 1630 app. 1630.2(o), (p), 1630.9 (1997)

            A Technical Assistance Manual on the Employment Provisions (Title 1) of the Americans with Disabilities Act 111, 8 FEP Manual (BNA) 405:6981, 6998-7018 (1992). The Manual includes a 200-page Resource Directory, including federal and state agencies, and disability organizations that can provide assistance in identifying and locating reasonable accommodations.

        The EEOC also has discussed issues involving reasonable accommodation in the following guidance and documents:

            Enforcement Guidance: Preemployment Disability-Related Questions and Medical Examinations at 5, 6-8, 20, 21-22, 8 FEP Manual (BNA) 405:7191, 7192- 94, 7201 (1995)

            Enforcement Guidance: Workers' Compensation and the ADA at 15-20, 8 FEP Manual (BNA) 405:7391, 7398-7401 (1996)

            Enforcement Guidance: The Americans with Disabilities Act and Psychiatric Disabilities at 19-28, 8 FEP Manual (BNA) 405:7461, 7470-76 (1997)

            Fact Sheet on the Family and Medical Leave Act, the Americans with Disabilities Act, and Title VII of the Civil Rights Act of 1964 at 6-9, 8 FEP Manual (BNA) 405:7371, 7374-76 (1996)

            Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees Under the Americans with Disabilities Act at 20, 22, 23, 24-5, 8 FEP Manual (BNA) 405:7701, 7711, 7712-14, 7715-16 (2000)

            Equal Employment Opportunity Commission's "Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act"

All of the above-listed documents, with the exception of the ADA Technical Assistance Manual and Resource Directory are also available through the Internet at http://www.eeoc.gov.


2.   CAP Technology Evaluation Center (CAPTEC)

The Pentagon, Room 2A259

(703) 693-5160 (Voice) or (703) 693-6189 (TTY)


The Review Commission has entered into a partnership with the Computer/Electronic Accommodations Program (CAP) in the Department of Defense to provide assistive technology, devices, and services. CAP offers a wide variety of assistive technology for people with hearing, visual, dexterity, cognitive of communication disabilities. Some of the assistive technology include alternative key boards, pointing devices, print enlargers, screen readers, speech recognition software, and teletypewriters.


3.   Job Accommodation Network (JAN)

1-800-232-9675 (Voice/TT)



A service of the President's Committee on Employment of People with Disabilities. JAN can provide information, free-of-charge, about many types of reasonable accommodations.


4.   ADA Disability and Business Technical Assistance Centers (DBTACS)

1-800-949-4232 (Voice/TT)


The DBTACs consist of 10 federally funded regional centers that provide information, training, and technical assistance on the ADA. Each center works with local business, disability, governmental, rehabilitation, and other professional networks to provide current ADA information and assistance, and places special emphasis on meeting the needs of small businesses. The DBTACs can make referrals to local sources of expertise in reasonable accommodations.


5.   Registry of Interpreters for the Deaf

(301) 608-0050 (Voice/TT)


The Registry offers information on locating and using interpreters and transliteration services.


6.   RESNA Technical Assistance Project

(703) 524-6686 (Voice) (703) 524-6639 (TT)



RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America, can refer individuals to projects in all 50 states and the six territories offering technical assistance on technology-related services for individuals with disabilities. Services may include:


        information and referral centers to help determine what devices may assist a person with a disability (including access to large data bases containing information on thousands of commercially available assistive technology products),

        centers where individuals can try out devices and equipment,

        assistance in obtaining funding for and repairing devices, and

        equipment exchange and recycling programs.

                                                                                                                                               Attachment 1


Applicant or Employee’s Name:

Name of individual requesting reasonable accommodation (if other than an applicant or employee):



Telephone Number:

Employee’s Office: Today’s Date:

Date of Request (if request was initiated orally):

ACCOMMODATION REQUESTED: (If you do not know what specific accommodation you need, pleased indicate that you will need assistance in deciding what accommodation would be appropriate.)


If accommodation is time sensitive, please explain:



                                                                      Signature of the Supervisor, Office Head, or Executive Director

Date Received:


(Return a copy of this document to the requestor once the confirmation is signed)


                                                                                                                                              Attachment 2


1.    Name of employee or applicant requesting reasonable accommodation:


2.    Type(s) of reasonable accommodation requested:

3.    Request for reasonable accommodation denied because: (you may check more than one box)

          Accommodation ineffective

          Accommodation would cause undue hardship to the operations of the Agency

          Medical documentation is inadequate

          Accommodation would require removal of an essential function

          Accommodation would require lowering of performance or production standard

          Other (please specify)


4.    Detailed explanation for the denial of the request for reasonable accommodation (You must be specific, e.g., why is the accommodation ineffective or why does it cause undue hardship. You may continue the explanation in an attachment, if necessary):


5.    If the individual rejected an offer for a different type of accommodation, explain the reasons why you believe that the chosen accommodation would be effective.

Employee Rights to Request Reconsideration, file an EEO complaint, and/or pursue MSPB procedures:

If you wish to request reconsideration of this decision:

Ask the decision maker to reconsider his/her denial. You may present new or additional information to support your request. If the decision maker does not reverse the denial, you may ask another official to do so as follows:

       Request Denied by:                                                            Other Official:

       Supervisor                                                                            Office Head

       Office Head                                                                          Executive Director

       Executive Director                                                               Chairman

If you wish to file an EEO complaint, or pursue MSPB procedures:

For an EEO complaint pursuant to 29 C.F.R. 1614, contact an EEO counselor within 45 days from the date of this notice. To pursue Merit Systems Protection Board procedures, for appeal able adverse actions as defined in 5 C.F.R. 1201.3, initiate an appeal within 30 days from the date of this notice

Name of Deciding Official:                        Signature:


                                                                                      Attachment 3  

CAP Office Use Only

Request #: [ ] EFMP [ ] Flexi

Received: [ ] DDESS [ ] WC

Completed: [ ] DoDDS [ ] CTRS

Approved: [ ] MTF [ ] DoD

Ordered: [ ] Non-DoD [ ] State




Item Description:

CAP Accommodation Request Form

     Complete this form to request assistive technology and services. Please ensure completion of all contact information. Approval is required from requester’s supervisor. Signature certifies that the accommodation is necessary for a person with a disabling condition to accomplish an essential job requirement. Signature also verifies that the item requested becomes the property of the receiving Federal Agency. Furthermore, equipment maintenance beyond initial warranty period and additional supplies after receipt of equipment is the responsibility

of the Federal agency. If you have any questions, please call CAP at 703-681-8813 (V) 703-681-0881 (TTY), or

email CAP@tma.osd.mil.

Complete the form online at http://www.tricare.osd.mil/cap/requests/accommodation_req_form.cfm

or you may fax completed form to 703-681-9075. You may also send by US Mail to:


DoD Computer/Electronic Accommodations Program Office

TRICARE Management Activity

5111 Leesburg Pike, Five Skyline Place, Suite 810

Falls Church, VA 22041-3206




Grade Level: _____ Occupational Series:_____ Are you a new federal employee?

Have you used CAP services before? [ ] Yes [ ] No

Please include your CUSTOMER ID # (if known)


2. ADDRESS/CONTACT INFORMATION: (No P.O. Boxes - No acronyms)

If your agency is within DoD (specify):

Organization: [ ] Army [ ] Navy [ ] Air Force


If your agency or department is not a DoD Agency (specify name): 




Address 1:

Address 2:

City, State, Zip:

Telephone/TTY#: (please indicate which)

Fax #: Email Address:


3. DISABILITY INFORMATION: Identify your disability (Deaf/Hard of Hearing, Blind/Low Vision, Cognitive, Dexterity*: Additional information/medical documentation may be required to support the need of an accommodation per the Rehabilitation Act)


Other (explain)

*Dexterity Disability (explain)


If you are a Workers’ Compensation claimant, include your Workers' Compensation Claim # and copy of Department of Labor Claim Acceptance Letter:

If you are Flexiplace, include your agency agreement form.


Please fax supporting documents to 703-681-9075.




Page 1                                                                                                                                                                                      CAP 9/01




Name (print): Signature:

Telephone/TTY #: Fax #:


 T T T E Q U I P M E N T T T T


5. ITEM REQUESTED: Include brand name/model and attach any vendor information/brochures you may

have. If requesting Speech Recognition Software, complete and fax the Speech Recognition Information

Form, located under “News/Documents” on the CAP website.


6. JUSTIFICATION: Please explain how this item will assist you in completing the essential functions of

your job.


7. OPERATING SYSTEM: In order to establish compatibility, identify your computer operating system:


 Win00___ Win98___ WinME___ WinNT___ Win95 ___ Mac ___ Other______




 T T T F U N D E D S E R V I C E T T T


Note: Complete this section only if you are requesting one of our funded services, which are: Reader, Interpreter, or Personal Assistant. A training session or travel must last two or more days. Submit a fully completed request at least 15 days prior to the start of the training or travel. Complete both sections A and B.


Identify which funded service you are requesting from the list above



Who is providing the training? (please check one) [ ] Private Company [ ] Government Agency


Training/Course Title:


Course Location:


Course Dates: Course Time:

Have you been officially registered for training?




For interpreting service information refer to the CAP Interpreter Database, located under “Deaf Accommodation Services” on the website and for information on obtaining a personal assistant please refer to the CAP Personal Assistant Guidelines, located under “Documents” on the website.


Agency/Service Provider Name, Point of Contact and Address:


Telephone/TTY #: Fax #:

Cost/Quote (please attach): Does service accept Credit Card Payment:

Email: Website:


Submitting this form signifies you agree to CAP terms and conditions.


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                                                                                                                                                 Attachment 4


A. Individual

     1.      Name of individual requesting reasonable accommodation:

     2.      Office of requesting individual:

     3.      Job held or desired by individual requesting accommodation: Grade Occupational Series: Title: Office:

     4.      For third party request, name of the individual making the request:


B. Request

     1.      Reasonable accommodation: (check one) Approved Denied ____________ (If denied, attach a copy of the “Denial of Request for Reasonable Accommodation” form.)

     2.      Date reasonable accommodation was requested:

     3.      Who received the request:

               4.           Date reasonable request was referred to decision maker (i.e., supervisor, office head, Executive Director, Personnel Management Specialist):

     5.      Name of the decision maker:

     6.      Date reasonable accommodation was approved or denied:

     7.      Date the reasonable accommodation was provided:

     8.      If the time frames outlined in the directive were not met, please explain why.


C. Accommodation


     1.      Reasonable accommodation was needed for: (circle one)

                                        Application Process

                                        Performing Job Functions or Accessing the Work Environment

                                        Accessing a Benefit or Privilege of Employment (e.g., attending a training program or social event)


     2.      Type(s) of reasonable accommodation requested: (circle one)

                                        Adaptive equipment


                                        Removal of Architectural Barrier

                                        Change in Work Schedule

                                        Staff Assistant

                                        Other. Please describe:


     3.      Type(s) of reasonable accommodation that was provided (if different from what was requested):


     4.      Was medical information required to process the request? Yes No

If yes, explain why.


     1.      Sources of technical assistance, if any, consulted in trying to identify possible reasonable accommodations (e.g., CAP, disability organization, Disability Program Manager):




Name of Deciding Official:   Signature:


This form must be completed and submitted to the Executive Director within 10 days of the decision.