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Request for Reasonable Accommodation: $50.00

Employees with medical disabilities are entitled to ask their employer to make reasonable accommodations at the work place for the employee's disability. This form can be used by the employee to make a request as well as offer suggestions for solutions to the employee's need for accommodation. Employers are required to comply so long as the request does not impose an undue hardship to the employer. To receive guidance on specific problems and possible solutions, call the Office of Disability Employment Policy's Job Accommodation Network at 800-526-7234, or 800-ADA-WORK (800-232-9675), or, with computer and modem, 800-DIAL-JAN (800-342-5526).

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