This policy applies to staff, contractors, interns, applicants, and certain volunteers of The Arc as determined by the immediate supervisor.

Reference:  Americans with Disabilities Act of 1973

ADA Amendments Act of 2008

Genetic Information Act of 2008

Privacy Act of 1974

It is The Arc’s policy not to discriminate against qualified individuals with a disability with regard to any aspect of employment.  The Arc is committed to complying with the American with Disabilities Act, as amended.

The Arc recognizes some individuals with disabilities may require reasonable accommodations.  If you are disabled or become disabled (meaning you have a mental or physical impairment substantially limiting one or more of the major life activities) and you require a reasonable accommodation, you must contact your supervisor  to begin the interactive process, which will include discussing your disability, limitations, and possible reasonable accommodations that may enable you to perform the functions or your position, make the workplace readily accessible to and usable by you, or otherwise allow you to enjoy equal benefits and privileges of employment.

Requirements:

The Arc is committed to providing reasonable accommodation to its employees and applicants for employment to ensure that individuals with disabilities enjoy equal access to all employment opportunities.  The Arc provides reasonable accommodation:

  • When an applicant with a disability needs an accommodation to have an equal opportunity to compete for a job;
  • When an employee with a disability needs an accommodation to perform the essential functions of the job or to gain access to the workplace; and
  • When an employee with a disability needs an accommodation to enjoy equal access to benefits and privileges of employment (e.g., temporary reassignment, trainings, office-sponsored events).

A reasonable accommodation is any change to the workplace or the way things are customarily done that provides an equal employment opportunity to an individual with a disability.  While there are some things that are not considered reasonable accommodations (e.g., removal of an essential job function or personal use items such as a hearing aid that is needed on and off the job), reasonable accommodations can cover most things that enable an individual to apply for a job, perform a job, or have equal access to the workplace and employee benefits such as kitchens, parking lots, and office events.

Common types of accommodations include:

  • Modifying work schedules or supervisor methods
  • Granting breaks or providing leave
  • Altering how or when job duties are performed
  • Removing and/or substituting a marginal function
  • Moving to different office space
  • Providing telework beyond that provided by their position description.
  • Making changes in workplace policies
  • Providing assistive technology, including information technology and communications equipment or specially designed furniture
  • Providing a reader or other staff assistant to enable employees to perform their job functions, where the accommodation cannot be provided by current staff
  • Removing an architectural barrier, including reconfiguring work spaces
  • Providing accessible parking
  • Providing materials in alternative formats (e.g., Braille, large print)
  • Providing a reassignment to another job

The Arc shall process requests for reasonable accommodation and shall provide reasonable accommodations where appropriate and within our ability, in a prompt and efficient manner in accordance with the time frames set forth in these Procedures.

The employee’s supervisor will obtain and evaluate documentation supporting an accommodation request (such as medical documentation demonstrating that the requestor is an individual with a disability), whenever the disability or need for accommodation is not obvious.

Sometimes the supervisor may be able to address an employee’s impairment-related needs outside the reasonable accommodation process.  This will be done on a case-by-case basis, and if so determined, a Memorandum for the Record will be filed by the employee’s supervisor or applicable manager.

I. Reasonable Accommodation Procedures

Requesting Reasonable Accommodation.  Generally, an applicant or employee must let a supervisor or applicable manager know that he/she needs an adjustment or change concerning some aspect of the application process, the job, or a benefit of employment for a reason related to a medical condition.  An applicant or employee may request a reasonable accommodation at any time, orally or in writing.

The reasonable accommodation process begins as soon as the oral or written request for accommodation is made to any manager in an employee’s chain of command, so it is imperative that the request be forwarded to the Executive Director within 2 business days.

An individual’s receipt or denial of an accommodation does not prevent the individual from making another request if circumstances change and she believes that an accommodation (Appendix A) is needed due to limitations from a disability (e.g., the disability worsens or an employee is assigned new duties that require an additional or different reasonable accommodation).  Additionally, the supervisor may not refuse to process a request for reasonable accommodation, and a reasonable accommodation may not be denied, based on a belief that the accommodation should have been requested earlier (e.g., during the application process).

A request does not have to include any special words, such as “reasonable accommodation,” “disability,” or Rehabilitation Act.”  A request is any communication in which an individual asks or states that he/she needs The Arc to provide or to change something because of a medical condition.  A supervisor, manager, or the Executive Director should ask an individual whether he/she is requesting a reasonable accommodation if the nature of the initial communication is unclear.

A family member, health professional, or other representative may request an accommodation on behalf of an employee or applicant.  For example, a doctor’s note outlining medical restrictions for an employee constitutes a request for reasonable accommodation.

When an individual (or third party) makes an oral request, the supervisor or applicable manager must ensure that the “Confirmation of Request” form is filled out (see Appendix B).  The supervisor or applicable manager must fill out the form if the requestor does not.

Reassignment

There are specific considerations in the interactive process when an employee needs, or may need, a reassignment.

  • Generally, reassignment will only be considered if no accommodations are available to enable the individual to perform the essential functions of his or her current job, or if the only effective accommodation would cause undue hardship.
  • In considering whether there are positions available for reassignment, the supervisor or applicable manager will work with the Executive Director and the employee requesting the reassignment to identify (1) vacant positions within the organization for which the employee may be qualified, with or without reasonable accommodation, and (2) positions which the organization believes will become vacant within 60 days from the date the search is initiated and for which the employee may be qualified.
  • Reassignment may be made to a vacant position outside of the employee’s commuting area if the employee is willing to relocate. As with other transfers not required by management, the organization will not pay for the employee’s relocation needs.

II. Requests for Medical Information

If the requestor’s disability and/or need for accommodation are not obvious or already known, the supervisor or applicable manager is entitled to ask for and receive medical information showing that the requestor has a covered disability that requires accommodation (see Appendix C)A disability is obvious or already known when it is clearly visible or the individual previously provided

medical information showing that the condition met with Rehabilitation Act definition.  It is the

responsibility of the applicant/employee to provide appropriate medical information requested by the supervisor or applicable manager where the disability and/or need for accommodation are not obvious or already known.

Only the supervisor or applicable manager may determine whether medical information is needed and, if so, may request such information from the requestor and/or the appropriate health professional.  Even if medical information is needed to process a request, the supervisor or applicable manager does not necessarily have to request medical documentation from a health care provider, in many instances the requestor may be able to provide sufficient information that can substantiate the existence of a “disability” and/or need for a reasonable accommodation.  If an individual has already submitted medical documentation in connection with a previous request for accommodation, the individual should immediately inform the supervisor or applicable manager of this fact.  The supervisor or applicable manager will then determine whether additional medical information is needed to process the current request.

If the initial information provided by the health professional or volunteered by the requestor is insufficient to enable the supervisor or applicable manager to determine whether the individual has a “disability” and/or that an accommodation is needed, the supervisor or applicable manager will explain what additional information is needed.  If necessary, the individual should then ask his/her health care provider or other appropriate professional to provide the missing information.  The supervisor or applicable manager may also give the individual a list of questions to give to the health care provider or other appropriate professional to answer.  If sufficient medical information is not provided by the individual after several attempts, the supervisor or applicable manager may ask the individual requesting accommodation to sign a limited release permitting the supervisor or applicable manager to contact the provider for additional information.  The supervisor or applicable manager may have the medical information reviewed by a doctor of the organization’s choosing at the organization’s expense.

In determining whether documentation is necessary to support a request for reasonable accommodation and whether an applicant or employee has a disability within the meaning of the Rehabilitation Act, the supervisor or applicable manager will be guided by principles set forth in the ADA Amendments Act of 2008.  Specifically, the ADA Amendments Act directs that the definition of “disability” be construed broadly and that the determination of whether an individual has a “disability” generally should not require extensive analysis.  Notwithstanding, the supervisor or applicable manager may require medical information in order to design an appropriate and effective accommodation.

A supervisor or office director who believes that an employee may no longer need a reasonable accommodation should contact the Executive Director.  The supervisor will decide if there is a reason to contact the employee to discuss whether he/she has a continuing need for reasonable accommodation.

III.  Confidentiality Requirements

Under the Rehabilitation Act, medical information obtained in connection with the reasonable accommodation process must be kept confidential.  This means that all medical information that The Arc obtains in connection with a request for reasonable accommodation must be kept in files separate from the individual’s personnel file.  This includes the fact that an accommodation has been requested or approved and information about functional limitations.  It also means that any employee who obtains or receives such information is strictly bound by these confidentiality requirements.

The supervisor or applicable manager may share certain information with other organization official(s) as necessary to make appropriate determinations on a reasonable accommodation request.  Under these circumstances, the supervisor will inform the recipients about these confidentiality requirements.  The information disclosed will be no more than is necessary to process the request.  In certain situations, the supervisor or applicable manager will not necessarily need to reveal the name of the requestor and/or the office in which the requestor works, or even the name of the disability.

In addition to disclosures of information needed to process a request for accommodation, other disclosures of medical information are permitted as follows:

  • Supervisors and managers are entitled to whatever information is necessary to implement restrictions on the work or duties of the employee or to provide a reasonable accommodation.
  • First aid and safety personnel may be informed, when appropriate, if the disability might require emergency treatment or assistance in evacuation, and
  • Government officials may be given necessary information to investigate the organization’s compliance with the Rehabilitation Act.

IV. Time Frame for Processing Requests and Providing Reasonable Accommodation

The time frame for processing a request (including providing accommodation, if approved) is as soon as possible but no later than 30 business days from the date the request is made. This 30-day period includes the 10-day time frame in which the supervisor or applicable manager must contact the requestor after a request for reasonable accommodation is made.

The organization will process requests and, where appropriate, provide accommodations in as short a period as reasonably possible.  The time frame above indicates the maximum amount of time it should generally take to process a request and provide a reasonable accommodation.  The supervisor will strive to process the request and provide an accommodation sooner, if possible.  Unnecessary delays can result in a violation of the Rehabilitation Act.

The time frame begins when an oral or written request for reasonable accommodation is made, and not necessarily when it is received by the supervisor or applicable manager.  Therefore, everyone involved in processing a request should respond as quickly as possible.  This includes referring a request to the supervisor, contacting a doctor if medical information or documentation is needed, and providing technical assistance to the supervisor or applicable manager regarding issues raised by a request (e.g., information from a supervisor regarding the essential functions of an employee’s position, information gathered regarding compatibility of certain adaptive equipment, etc.).

The supervisor or applicable manager must request medical information or documentation from a requestor’s doctor.  The time frame will stop on the day that the supervisor or applicable manager makes a request to the individual to obtain medical information or sends out a request for information/documentation, and will resume on the day that the information/documentation is received by the supervisor or applicable manager. 

If the disability is obvious or already known to the supervisor or applicable manager, if it is clear why reasonable accommodation is needed, and if an accommodation can be provided quickly, then the supervisor or applicable manager should not require the full 30 business days to process the request.  The following are examples of situations where the disability is obvious or already known and an accommodation can be provided in less than the allotted time frame.

  • An employee with insulin-dependent diabetes who sits in an open area asks for three breaks a day to test his/her blood sugar levels in private.
  • An employee with clinical depression who takes medication which makes it hard for her to get up in time to get to the office at 9:00 a.m., requests that she be allowed to start work at 10:00 a.m., and still work an eight-and-a-half-hour day.
  • A supervisor distributes a detailed agenda at the beginning of each staff meeting. An employee with a serious learning disability asks that the agenda be distributed ahead of time because his disability makes it difficult to read quickly and he/she needs more time to prepare.

Expedited Processing of a Request.

In certain circumstances, a request for reasonable accommodation requires an expedited review and decision.  This includes where a reasonable accommodation is needed.

  • To enable an applicant to apply for a job. Depending on the timetable for receiving applications, conducting interviews, taking tests, and making hiring decisions, there may be a need to expedite a request for reasonable accommodation to ensure that an applicant with a disability has an equal opportunity to apply for a job.
  • To enable an employee to attend a meeting scheduled to occur soon. For example, an employee may need a sign language interpreter for a meeting scheduled to take place in 5 days.

Extenuating Circumstances.

These are circumstances that could not reasonably have been anticipated or avoided in advance of the request for accommodation, or that are beyond the organization’s ability to control.  When extenuating circumstances are present, the time for processing a request for reasonable accommodation and providing the accommodation will be extended as reasonably necessary.  Extensions will be limited to circumstances where they are absolutely necessary and only for as long as required to deal with the extenuating circumstance.

V. Resolution of the Reasonable Accommodation Request

All decisions regarding a request for reasonable accommodation will be communicated to an applicant or employee by use of the “Resolution Request” form (See Appendix D), as well as orally.

  1. If the Executive Director grants a request for accommodation, the supervisor or applicable manager will give the “Resolution of Request” form to the requestor, and discuss implementation of the

accommodation.  The “Resolution” form must be filled out even if the Executive Director is granting the request without determining whether the requestor has a “disability” and regardless of what type of

change or modification is approved (e.g., the supervisor grants a three-month removal of an essential function, which is not a form of reasonable accommodation but nonetheless must be specified on the Resolution form).

  • A decision to provide an accommodation other than the one specifically requested will be considered a decision to grant an accommodation. The form will explain both the reasons for the denial of the individual’s specific requested accommodation and why the supervisor or applicable manger believes that the chosen accommodation will be effective.
  • If the request is approved but the accommodation cannot be provided immediately, the supervisor or applicable manager will inform the individual in writing of the projected time frame for providing the accommodation

2. If the Executive Director denies a request for accommodation, the supervisor or Applicable manager will give the “Resolution” form to the requestor and discuss the reason(s) for the denial. When completing the “Resolution” form, the explanation for the denial will clearly state the specific reason(s) for the denial. This means that the Executive Director cannot simply state that a requested accommodation is denied because of “undue hardship” or because it would be “ineffective.”  Rather, the form will state and the supervisor or applicable manager will explain specifically why the accommodation would result in undue hardship or why it would be ineffective.

  • If there is a legitimate reason to deny the specific reasonable accommodation requested (e.g., the accommodation poses an undue hardship or is not required by the Rehabilitation Act), the supervisor or applicable manager will explore with the individual whether another accommodation would be possible. The fact that one accommodation proves ineffective or would cause undue hardship does not necessarily mean that this would be true of another accommodation.  Similarly, if an employee requests removal of an essential function or some other action that is not required by law, the supervisor or applicable manger will explore whether there is a reasonable accommodation that will meet the employee’s needs.
  • If the supervisor or applicable manager offers an accommodation other than the one requested, but the alternative accommodation is not accepted, the supervisor will record the individual’s rejection of the alternative accommodation on the “Resolution” form.

 

VI. Informal Dispute Resolution

 

An individual dissatisfied with the resolution of a reasonable accommodation request can ask the Executive Director to reconsider that decision.  An individual must request reconsideration within 10 business days of receiving the “Resolution” form.  A request for reconsideration will not extend the time limits for initiating administrative, statutory, or collective bargaining claims.

Information Tracking and Reporting

In order for the Executive Director to ensure compliance with these Procedures and the Rehabilitation Act, the supervisor or the applicable manager will complete the “Reasonable Accommodation Information Reporting form (Appendix D) within 5 business days of issuing the decision.

These forms will be the basis of an annual report to be issued to all employees that will provide a qualitative assessment of the Executive Director’s reasonable accommodation program, including any recommendations for improvement of the Executive Director’s reasonable accommodation policies and these Procedures.  This annual report will not contain confidential information about specific requests for reasonable accommodations, such as the names of individuals that requested accommodations or the accommodations requested by specific individuals.   Rather, this report will provide only general information, such as the total number of requests for accommodations, the types of accommodations requested, and the length of time taken to process requests.

Inquiries and Distribution

Any employee wanting further information concerning these Procedures may contact their supervisor or applicable manager, or applicants may contact the Executive Director or the supervisor or applicable manager where they are applying for employment by phone or via email at execdir@hrarc.org or arc@hrarc.org .

APPENDICES:

Appendix A:  Request for Reasonable Accommodation Form

Appendix B:  Confirmation of Request for Reasonable Accommodation Form

Appendix C:  Physician’s (or Caregiver’s) Questionnaire

Appendix D:  Supervisor/Applicable Manager Accommodation Information

Reporting Form (Resolution Request)

Appendix A

EMPLOYEE/APPLICANT REQUEST FOR REASONABLE ACCOMMODATION FORM  

To initiate the reasonable accommodation process, please fully complete this form and then forward the form to your supervisor or applicable manager.  Any questions you might have should be directed to your supervisor, applicable manager, or Executive Director in that order.

Name of Employee (or Applicant for Employment) __________________________________________

Department: _________________________________________________________________________

Work Schedule (Days & Hours) _________________________________________________________

Nature of Condition(s) _________________________________________________________________

____________________________________________________________________________________

Please describe any medical restriction resulting from your condition ____________________________

____________________________________________________________________________________

Please describe any medical restrictions resulting from your condition ___________________________

____________________________________________________________________________________

Please describe how your condition and any resulting medical restriction affects your ability to

perform your job _____________________________________________________________________

____________________________________________________________________________________

Please describe how you believe we can accommodate your condition _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please attach additional pages as necessary as well as any supporting medical documentation, and execute the attached medical release.  However, the Genetic Information Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law.  To comply with this law, we ask that you not provide any genetic information when responding to the request for medical information.  “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

Employee signature_____________________________________   Date ___________________

Appendix B

CONFIRMATION OF REQUEST FOR REASONABLE ACCOMMODATION

 

_____________________________________              _______________________________

Applicant’s or Employee’s Name                                   Telephone Number

_____________________________________              _______________________________

Date of Request                                                              Employee’s Office within The Arc

___________________________________________________________________________

  1. Type of Accommodation Requested, if known. (Be as specific as possible, e.g., assistive

technology, reader, interpreter, schedule change).

___________________________________________________________________________

  1. Reason for request. (If accommodation is time sensitive, please explain).

 

___________________________________________________________________________

Privacy Act Statement.  The Rehabilitation Act of 1973, 29 U.S.C. section 791, and the Executive Order 13164 authorize collection of this information.  The primary use of this information is to consider, decide, and implement requests for reasonable accommodation.  Additional disclosures of the information may be:  To medical personnel to meet a bona fide medical emergency; to another Federal agency, a court, or a party in litigation before a court or in an administrative proceeding being conducted by a Federal agency when the Government is a party to the judicial or administrative proceeding; to a congressional office from the record of an individual in response to an inquiry from the congressional office made of the request of the individual; and to an authorized appeal grievance examiner, formal complaints examiner, administrative judge, equal employment opportunity investigator, arbitrator or other duly authorized official engaged in investigation or settlement of a grievance, complaint or appeal filed by an employee.

Appendix C    

PHYSICIAN (or Caregiver) QUESTIONNAIRE

Your patient is an employee of The Arc of Harrisonburg and Rockingham and has requested an accommodation.  In order to expedite the processing of your patient’s request for an accommodation, please be as complete and specific as possible.  Once completed, please return this document to your patient.  The patient will return the document to The Arc.  PLEASE PRINT OR TYPE YOUR RESPONSES.

 

Name of Patient:

 

Name of Caregiver:

 

Title:

 

Address:

 

Brief description of practice:

 

 

SECTION ONE:  PHYSICAL OR MENTAL IMPAIRMENT

  1. Does your patient have any physical or mental impairment? _____   No        _____ Yes

If yes, please state the impairment(s): _______________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

  1. If your patient has a history of the impairment indicated in question #1, please indicate the date the condition commenced and describe in detail any previous medical restrictions associated with the impairment and the degree to which your patient was limited: ____________________________

______________________________________________________________________________

______________________________________________________________________________

NOTE:  The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law.  To comply with this law, we are asking tht you not provide any genetic information when responding to this request for medical information.  “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

  1. If a life activity is limited by the physical or mental impairment listed in question #1, please identify which life activity is limited. (Please check all that apply).

_____Caring for oneself         _____Walking     _____Seeing     _____Hearing     _____Eating

_____Performing manual tasks     _____Speaking     _____Breathing     _____Learning

_____Working     _____Concentrating     _____Standing     _____Sitting     _____Bending

_____Toileting     _____Lifting     _____Interacting with others     _____Hearing

_____Sleeping     _____Reaching     _____Reading     _____Thinking     _____Other

(Please specify) ______________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

  1. Please specify how and to what degree your patient is limited in each of the life activities identified in Question #3. For example:  If lifting was identified as a limited life activity, how many pounds can your patient lift frequently/occasionally?  If working was identified, please specify the class of jobs or broad range of jobs that your patient is unable/able to perform.  If performing manual tasks was identified, please specify the tasks that are important to most people’s daily lives that your patient is unable/able to perform.

Life Activity                           To What Degree Restricted                            Able to Perform

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

If your patient’s impairment is episodic in nature, how often and for what period of time do symptoms occur?   ______________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

  1. How long will your patient be limited in performing the life activity or activities as described above? _____________________________________________________________________________

_____________________________________________________________________________

 

SECTION TWO:  ACCOMMODATION

  1. Please review the patient’s job requirements in the attached job description. Do the limitations you previously identified restrict your patient’s ability to perform the job or comply with the requirements of the position? _____No     _____Yes.  If yes, please identify the functions of your patient’s job he or she is able to perform and those functions he or she is unable to perform.

Able                                                                            Unable

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

  1. Does the employee require a leave of absence? _____Yes     _____ No

Would your patient’s leave be:

Continuous     _____                                                              Intermittent    _____

If continuous, would your patient’s leave be:

Indefinite   _____No     _____Yes

If not indefinite, please specify time period and return to work date: _____________________

If intermittent, please specify the number of days per month or week that your patient

would require a leave, as well as the period of time the intermittent leave is needed for:

______________________________________________________________________________

  1. In your opinion, if your patient cannot perform his or her current job with or without reasonable accommodation, would your patient be able to work in another position?

_____No   ____ Yes.  If yes, please specify what other position or work the patient can do.

______________________________________________________________________________

______________________________________________________________________________

SECTION THREE:  THREAT TO SELF OR OTHERS

 

  1. Would performing all of the function of the Employee’s job, either with or without an accommodation, result in a direct threat (significant risk of substantial harm) to the safety or health of the employee or other persons? _____Yes      _____No
  1. Please describe any direct threat to health or safety identified in Question #9.

______________________________________________________________________________

______________________________________________________________________________

  1. Would an accommodation eliminate the direct threat to health or safety, or reduce it to below the level of a direct threat? _____Yes      _____No       _____Not Applicable

If yes, what accommodation, if any, would eliminate any direct threat, or reduce it below the level of a direct threat?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

The individual named above is my patient.  The information provided here is based upon my knowledge of the patient and the patient’s physical or mental impairment.

 

 

________________________________________              ___________________________

Signature of Physician or Caregiver                                     Date

 

______________________________

Phone

 

______________________________

Fax Number

 

EHS page 30

Appendix D

 

 SUPERVISOR/APPLICABLE MANAGER ACCOMMODATION INFORMATION REPORTING FORM (RESOLUTION REQUEST)

 

(Must complete numbers 1-3; complete numbers 4-7 if applicable)

PRINT OR TYPE:

  1. Name of individual requesting reasonable accommodation:
  1. Accommodation(s) requested:
  1. Accommodation(s): _____approved as specifically requested

_____approved but different from original request*

_____denied

*If the approved accommodation is different from the one(s) originally requested, identify

the alternative accommodation(s):

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

  1. If an alternative accommodation was offered, indicate whether it was:

_____ accepted                                         _____ rejected

  1. Request denied because: (may check more than one)
  • Requestor does not have a Rehabilitation Act disability       ________
  • Accommodation ineffective       ________
  • Accommodation would cause undue hardship       ________
  • Medical documentation inadequate       ________
  • Accommodation would require removal of essential function       ________
  • Accommodation would require lowering performance or production standard       ________
  • Other (please identify) ____________________________________________________

_______________________________________________________________________

  1. Detailed reason(s) for denial (Must be specific, e.g., why accommodation would be

Ineffective or cause undue hardship):

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________

  1. If the deciding official offered an accommodation that is different from the one originally requested, explain: (a) the reasons for the denial of the accommodation originally requested and (b) why the alternative accommodation would be effective.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

  1. An individual who disagrees with the resolution of the request may ask the Executive Director to reconsider that decision within 10 business days of receiving the “Resolution” form. Note that requesting reconsideration does not extend the time limits for initiating administrative, statutory, or collective bargaining claims.
  1. If you are dissatisfied with the resolution and wish to pursue administrative, statutory, or any other rights, you must take the following:
  • For an EEO complaint pursuant to 29 C.F.R. 1614, contact an EEO counselor in the Office of Equal Opportunity within 45 days from the date of receipt of this form or a verbal response

(whichever comes first).

  • For a grievance claim, file a written grievance in accordance with the provisions of The Arc’s policy

______________________________________                         __________________________

Name and Title of Deciding Official                                           Signature of Deciding Official

________________________________________

Date Reasonable Accommodation Denied/Approved

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