13661 Template

The 13661 form is a document used to request reasonable accommodations in the workplace for individuals with disabilities. It serves as a structured way for applicants or employees to articulate their needs and for decision-makers to assess those requests. Understanding the components of this form is crucial for ensuring that individuals receive the support they need to perform effectively in their roles.

If you are in need of reasonable accommodations, please fill out the form by clicking the button below.

Table of Contents

The 13661 form is a crucial document for individuals seeking reasonable accommodations in the workplace, particularly within the Internal Revenue Service (IRS). It comprises several parts, each designed to facilitate the accommodation process while ensuring compliance with relevant laws. Part I serves as the initial request section, where applicants or employees provide essential personal information and detail their medical conditions, the job functions affected, and the accommodations they seek. Part II is divided into two sections: the first is for the Deciding Official to document their assessment of the request, while the second part outlines the official's decision regarding the accommodation. Parts III-A and III-B focus on medical documentation, requiring input from healthcare practitioners or counselors to substantiate the need for accommodation based on the applicant's medical condition. Additionally, the form includes a section on the denial of requests, ensuring that all decisions are formally documented. Privacy considerations are paramount, as the form adheres to the Privacy Act and stipulates how information may be shared with relevant parties. Understanding the 13661 form's structure and requirements is essential for both applicants and officials involved in the accommodation process, as it lays the groundwork for ensuring that employees with disabilities receive the support they need to perform their roles effectively.

13661 Sample

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Instructions for Form 13661, Reasonable Accommodation Request

This form is intended to assist persons involved in the reasonable accommodation process and to

memorialize important information. Completion of the form, including medical documentation if the

condition is not obvious or history of, is strongly encouraged for Agency Reasonable Accommodation

Services (RAS) review and record keeping purposes.

Part I – Written Reasonable Accommodation Request

To be completed by applicant for employment, employee, representative, or by an IRS

official when necessary to document a reasonable accommodation request. Submitting

any medical or other supporting documentation with Part I will help expedite the

processing of the request for accommodation.

Part II-A – Deciding Official Documentation

To be completed by Supervisor or Deciding Official addressing management's decision.

Management makes the final decision on a request for accommodation.

Part II-B –

Deciding Official Documentation

To be completed by Supervisor or Deciding Official addressing management's decision.

Management makes the final decision on a request for accommodation. A temporary

request, condition, or accommodation should be documented on Part I and Part II with re-

evaluation or ending date.

Part III-A – Medical Documentation

To be completed by Health Care Practitioner, Social Worker, or Rehabilitation Counselor.

Part III-B – Medical Documentation (Limitations Worksheet)

To be completed by Health Care Practitioner, Social Worker, or Rehabilitation Counselor.

Note: Medical documentation is generally not required where the disability is obvious or

known to the Agency and the nexus between the disability and the requested

accommodation is apparent.

Part IV – Denial of Reasonable Accommodation Request

To be completed by Deciding Official to document the denial of reasonable

accommodation.

Authorization of Representation – To be completed by representative and/or employee for

authorized representation for request.

Collection of the requested information is authorized by Section 501 of the Rehabilitation Act, 29 U.S.C. § 791.The information you

furnish will be used for the purpose of facilitating your request. Additionally, the information may be used to disclose information to:

appropriate Federal, state or local agencies when relevant to civil, criminal or regulatory investigations or prosecutions when necessary

to adjudicate a claim for benefits; a Federal agency in connection with a decision in hiring, retention or the granting of a security

clearance. It may also be used in an administrative or judicial proceeding affecting an employee's personnel rights and in any criminal

prosecutions for willfully making false or fraudulent statements in violation of U.S.C. § 1001. Additional uses may include disclosure to

the Department of Justice for the purpose of litigating any civil, administrative, or judicial proceeding where the United States, the IRS,

or its employees (in their official capacities or where the government has decided to represent them) are parties. It may also be used in

response to subpoena from a third party provided that (1) IRS is a party in interest, (2) the records are relevant and necessary to the

litigation, and (3) not otherwise privileged. This information may be provided to professional associations, such as state bar disciplinary

authorities, for use in connection with their administration of standards of conduct. Further, it may be disclosed to contractors when

necessary to perform work associated with reasonable accommodation and to those Federal agencies that oversee property and

procurement matters. Furnishing the requested information is required to establish that you have a covered disability, the functional

limitations of your disability, and the need for reasonable accommodation. Failure to fully complete the form or refusal to provide the

requested documentation may lead to a breakdown in the reasonable accommodation process and could result in a determination that

you are not entitled to reasonable accommodation.

Privacy Act Statement

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Nondisclosure of GINA Protected Information

The Genetic Information and Nondiscrimination Act of 2008 (GINA) prohibits employers and other

entities covered by GINA Title II from requesting, requiring, or purchasing genetic information of

employees or their family members, except as specifically allowed by this law. GINA has specific

exceptions for requests under the Family and Medical Leave Act and the Rehabilitation Act, as

explained below. To comply with GINA, we are asking that you not provide any genetic information

when responding to this request for medical information, unless the information is allowable as

explained below.

“Genetic information”, as defined by GINA, includes information concerning the manifestation of

disease/disorder in family members (“family medical history”), information about 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. Document 12986 - Nondisclosure of GINA Protected Information

(Provided for your information).

Family and Medical Leave Act (FMLA)

The general prohibition against requesting or requiring genetic information does not apply where

an employer requests medical information of an employee who invokes the FMLA to attend to

the employee's own serious health condition or where an employee complies with the employer's

return to work certification requirements. See 29 CFR 1635.8(b)(1)(i)(D)(2). An employer does not

violate GINA by asking an employee seeking FMLA leave to care for a seriously ill family member to

provide family medical history to comply with the certification provisions of the FMLA. See 29 CFR

1635.8(b)(3).

Further, GINA permits disclosure of relevant genetic information consistent with the requirements of

the FMLA to persons with a need to know the information because of responsibilities relating to the

handling of FMLA requests. See 29 CFR 1635.9(b)(5).

Rehabilitation Act

The general prohibition against requesting or requiring genetic information does not apply where an

employer requests documentation to support a request for reasonable accommodation as long as the

request for documentation is lawful. Such a request is lawful only where the disability and/or the need

for accommodation is not obvious; the documentation required contains no more information than

what is sufficient to establish that an individual has a disability and needs reasonable accommodation;

and the documentation relates only to the impairment that the individual claims to be a disability that

requires reasonable accommodation. See 29 CFR 1635.8(b)(1)(i)(D)(1); see also 29 CFR 1635.8(b)

(1)(i)(B).

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part I

Part I. Written Reasonable Accommodation Request

To be completed by applicant, employee, or IRS official

1. Applicant/Employee information

Last name First name

2. Occupational

SEID Series Grade

3. Operating Division/Function

4. Contact information

Office telephone number FAX number Tour of Duty/Shift (work hours)

Post of Duty (POD) City State ZIP code

E-mail address Preferred method/time to contact (cell phone or email, hours)

Cubicle, floor, or building code

5. Mailing address (where you receive official correspondence)

Address 1

(work)

Address 2

(home)

Room # Mail Stop City State ZIP code

6. Manager's contact information

Manager's name Telephone number E-mail address

ZIP codeStatePost of Duty (POD) City

SEID

7. Medical condition

(Describe your medical condition requiring accommodation.)

8. Job functions affected

(Describe how your medical condition limits your ability to perform your current duties, participate in the application process,

or access a benefit of employment. Copy of position description or clarify essential job functions impacted.)

9. Accommodation requested

(Based on your disability or medical condition and job functions affected, what accommodations would help you to

perform effectively.)

10. List alternative accommodation options to consider

I affirm that all statements made above are true to the best of my knowledge and belief.

Signature of Applicant/Employee Date signed

Authorization of Representation Name / Contact Information (attach release form to package)

eFAX 855-679-8653 or * RA Form 13661

Page

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part II-A

Part II-A. Supervisor/Deciding Official Documentation

To be completed by Supervisor/Deciding Official

1. Name of Applicant/Employee RA case number

2. Supervisor/Deciding Official

Last name First name Title SEID

ZIP codeStatePost of Duty

(POD)

City

Telephone number

(Including Area Code)

E-mail address

3. Is the employee's/applicant's condition obvious or otherwise known to management

Yes No

4. What duties or functions of the job are limited by the applicant/employee's medical condition.

(Refer to the Position Description, Critical

Job Elements (CJE), applicant requirements, or other relevant documentation).

5. Does this limitation affect an essential function of the job or participation in the application process

(See RAC if

essential job function worksheet is needed).

Explain answer

Yes No

6. Will the requested accommodation allow the applicant/employee to successfully perform the

essential job functions or participate in the application process. Explain answer

Yes No Not sure

7. Describe any interim accommodation efforts, alternative accommodation recommendations or previously approved accommodations

8. Further medical information/review: Does management need additional medical information

Yes No

9. Potential review through Federal Occupational Health (FOH)

Yes No

If either additional medical information or review by FOH is necessary. Explain the need

(Additional medical information should not

be sought where the condition is obvious or known and the connection to the requested accommodation is apparent)

I affirm all statements made above are true to the best of my knowledge and belief.

Signature of Supervisor/Deciding Official Date signed

eFAX 855-679-8653 or * RA Form 13661

Reasonable Accommodation Request

Department of the Treasury - Internal Revenue Servicepublish.no.irs.govCatalog Number 39619X

Form

13661

(Rev. 10-2020)

Part II-B

Part II-B. Action by Deciding Official

To Be Completed After Review of Accommodation Request

Request approved Alternative accommodation approved Accommodation denied

If an alternative accommodation approved, describe accommodation approved

If the condition and/or accommodation is temporary, document specifics with date to re-evaluate. Review date

Signature of Deciding Official Date signed

Deciding Official

Last name

First name Title SEID

Telephone number

(Including Area Code)

E-mail address

Post of Duty

(POD)

City State ZIP code

eFAX 855-679-8653 or * RA Form 13661

Reasonable Accommodation Request

Department of the Treasury - Internal Revenue Servicepublish.no.irs.govCatalog Number 39619X

Form

13661

(Rev. 10-2020)

Part III-A Name of Health Care Practitioner, Social Worker, Rehabilitation Counselor Best method and time to contact Signature

Part III-A. Medical Documentation

To be completed by a Health Care Practitioner, Social Worker, or Rehabilitation Counselor

Name of Applicant/Employee

Instructions

We have been requested to consider a reasonable accommodation for the individual named above. An accommodation is a

modification made to a job and/or the work environment that enables a qualified employee/applicant with a disability to successfully

perform the essential duties or functions of the position. We request that you provide medical information which reflects:

• the individual has one or more physical or mental impairment that substantially limit(s) one or more of his/her major life activities

(e.g., walking, speaking, breathing, hearing, seeing, thinking, sitting, standing, reaching, interacting with others, learning,

performing manual tasks, caring for oneself, concentrating, lifting, working, sleeping),

• a relationship or nexus between the medical condition(s) and the recommended accommodation(s).

Medical Documentation; provide a copy of employee position or job description

1. Have you made a diagnosis that relates to this reasonable accommodation request? State the diagnosis

2. Describe what limitations result from this condition, address any workplace safety concerns or impact to perform essential job duties

that may result from the condition.

(Complete Part III-B)

3. What is the anticipated duration of this medical condition

4. Recommended options or alternatives for accommodation efforts

Certification

Name of Health Care Practitioner, Social Worker, Rehabilitation Counselor Telephone number Best method and time to contact

I understand an IRS medical consultant may contact me for additional information.

Signature Date signed

eFAX 855-679-8653 or

* RA Form 13661

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part III-B

Part III-B. Medical Documentation

To be completed by a Health Care Practitioner, Social Worker, or Rehabilitation Counselor

Name of Applicant/Employee

Instructions

1. The following table indicates the major life activity that is affected by the applicant/employee's medical condition. Major life

activities are those basic activities that the average person in the general population can perform with little or no difficulty.

2. Indicate only the major activity affected by the applicant / employee's medical condition by circling or checking the appropriate

block. Indicate the specific limitation of the applicant / employee resulting from their condition. Quantify their limitation in order for

the agency to determine appropriate workplace accommodations (1-2 hours, 100 feet, 75% of day, or other notation).

Activity Extent of Limitation Detailed Explanation/Recommendation

Sensory

Seeing/Vision

Hearing

Limited to:

Breathing/Respiratory

Limited to:

Speaking

Limited to:

Basic Mobility

Walking

Climbing stairs

Sitting

Standing

Limited to:

Hours per day

Distance

% of day

Secondary Mobility

Squatting/kneeling

Twisting (neck/waist)

Bending/stooping

Reaching above shoulder

Limited to:

Hours per day

Physical Exertion

Pushing/pulling

Lifting/Carrying

Limited to:

Number of pounds

Fine Motor Skills

Keyboard use

Repetitive use of hands

Grasping

Fine finger motions

Limited to:

Hours per day

Cognitive

Thinking

Learning

Comprehending

Concentrating

Limited to:

Caring for self

Self-medication/checks

Dressing

Limited to:

Mental/emotional

Limited to:

Sleeping

Limited to:

Other/Bodily Functions

Limited to:

Certification

Name of Health Care Practitioner, Social Worker, Rehabilitation Counselor Signature Date signed

eFAX 855-679-8653 or

* RA Form 13661

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part IV

Part IV. Denial of Reasonable Accommodation Request

To be completed by Deciding Official

Name of Applicant/Employee RA case number

Accommodation requested Accommodation offered to Applicant/Employee

1. Reason for denial

(check all that apply)

Accommodation Ineffective/Inappropriate

Accommodation Would Cause Undue Hardship

Employee did not accept an alternative accommodation offered

Medical Documentation Inadequate

Accommodation Would Require Removal of Essential Function

Accommodation Would Require Lowering of Performance or Production Standard

Other (Identify)

2. Detailed reason(s) for the denial of reasonable accommodation

(e.g., why accommodation is ineffective or causes undue hardship)

3. If the individual did not accept an alternative accommodation, explain how the alternative accommodation addresses the limitation,

and why you believe the chosen accommodation would be effective

4. Appeal Process:

• Refer to IRM 1.20.2.

• A request to the Deciding Official for reconsideration based on new medical documentation or other previously unavailable

information may be made within 15 business days of receipt of this denial.

• An appeal to the Business Unit Chief/Commissioner may be initiated within 15 business days of the denial of accommodation or

within 15 business days of a denial of a request for reconsideration by the Deciding Official, unless an alternative effective

accommodation has been offered.

• To initiate an EEO complaint contact an EEO counselor within the IRS within 45 calendar days of an allegedly discriminatory

action/event.

• Bargaining Unit employees may file a grievance in accordance with the terms of the collective bargaining agreement.

• An appeal to the Merit Systems Protection Board may be filed within 30 calendar days of an adverse action as defined in 5 C.F.R.

1201.3.

Signature of Deciding Official

(If denied)

Date signed

eFAX 855-679-8653 or * RA Form 13661

▼ 13661 PDF Form

Document Attributes

Fact Name	Details
Purpose	The 13661 form is designed for individuals to request reasonable accommodations due to a disability in the workplace.
Parts of the Form	The form consists of multiple parts, including sections for the applicant's request, medical documentation, and the decision by the official.
Privacy Act Compliance	Information collected is protected under the Privacy Act and is used solely to process the accommodation request.
GINA Compliance	The form complies with the Genetic Information Nondiscrimination Act (GINA) by prohibiting the collection of genetic information unless allowed by law.
Governing Laws	The 13661 form is governed by the Rehabilitation Act of 1973, specifically Section 501, along with GINA provisions.

13661: Usage Instruction

Filling out Form 13661 is an important step in requesting reasonable accommodation. This form has several parts that need to be completed by different individuals involved in the process. Make sure to provide accurate and complete information to ensure your request is processed efficiently.

Gather necessary information: Before starting, collect all relevant personal information, including your medical condition and how it affects your job performance.
Complete Part I: This section is for the applicant or employee. Fill in your last name, first name, occupational details, contact information, mailing address, and your manager's contact information. Describe your medical condition, how it affects your job functions, and the accommodations you are requesting.
Sign and date Part I: Make sure to affirm that all statements are true to the best of your knowledge.
Submit Part I: Send this section to the designated fax number or the assigned Reasonable Accommodation Coordinator.
Complete Part II: This part is for the Deciding Official. Fill in the name of the applicant, the date of the oral request, and your contact information. Assess the job limitations caused by the medical condition and whether the requested accommodations will help.
Sign and date Part II: Confirm that all statements are accurate.
Submit Part II: Return this section to the assigned Reasonable Accommodation Coordinator and provide a copy to the individual making the request.
Complete Parts III-A and III-B: If applicable, have a Health Care Practitioner, Social Worker, or Rehabilitation Counselor fill out these sections. They should provide a diagnosis, explain the impact of the medical condition, and outline any necessary medical documentation.
Return Parts III-A and III-B: Submit these completed sections to the assigned Reasonable Accommodation Coordinator.

After submitting the form, the Deciding Official will review the request and determine whether to approve or deny it. You will receive further communication regarding the outcome of your request.

Frequently Asked Questions

What is the purpose of Form 13661?
Form 13661 is used to request reasonable accommodations for individuals with disabilities in the workplace. This form allows employees or applicants to document their needs and provides a structured way for decision-makers to assess and respond to these requests.
Who should complete the form?
The form should be completed by the individual requesting the accommodation, which can include applicants for employment, current employees, or IRS officials. Depending on the situation, medical professionals may also need to provide additional documentation.
What information is required in Part I of the form?
In Part I, the requester must provide personal information such as:
- Full name
- Job title and series
- Contact information
- Details about the medical condition
- Job functions affected
- Requested accommodations
It’s essential to be as detailed as possible to facilitate the accommodation process.
What happens after the form is submitted?
Once the form is submitted, a Deciding Official will review the request. They will evaluate the medical documentation and determine whether the requested accommodations can be granted. The Deciding Official will then communicate their decision to the requester.
What if my request for accommodation is denied?
If your request is denied, the Deciding Official will complete Part IV of the form to document the reasons for the denial. You have the right to ask for clarification and may also consider appealing the decision if you believe it was unjust.
Is my medical information kept confidential?
Yes, the information provided on Form 13661 is protected under privacy laws. It will only be shared with individuals who need to know for processing your accommodation request. This includes relevant HR personnel and medical professionals involved in the evaluation.
What should I do if I need more space to provide information?
If you run out of space on the form, you can attach additional sheets with the necessary information. Ensure that all attached documents are clearly labeled and referenced in the appropriate sections of the form.

Common mistakes

Filling out Form 13661 can be a daunting task. Many people make mistakes that can delay their reasonable accommodation requests. Here are nine common errors to avoid.

First, many applicants fail to provide complete personal information. Missing details like contact numbers or mailing addresses can lead to unnecessary delays. Ensure that all sections, especially your contact information, are filled out accurately.

Second, people often neglect to describe their medical condition clearly. This section is crucial. A vague description may not give the deciding official enough information to understand the need for accommodation. Be specific about how your condition affects your daily activities.

Third, applicants frequently overlook the section about job functions affected by their medical condition. It’s important to explain how your limitations impact your ability to perform your job. Without this information, the request may lack the necessary context.

Fourth, some individuals do not specify the accommodations they need. Simply stating that you require help is insufficient. Clearly outline what adjustments would enable you to perform your job effectively.

Fifth, many people forget to sign and date the form. This may seem minor, but without a signature, the form is incomplete and could be rejected. Always double-check for your signature before submission.

Sixth, applicants sometimes ignore the option to provide additional comments. If there’s more to share that can support your request, use this space. Attachments are also acceptable if you need more room.

Seventh, some individuals fail to return the form to the correct fax number or coordinator. Sending it to the wrong place can delay the process significantly. Make sure you know where to send your completed form.

Eighth, people often forget to keep a copy of the submitted form. Having a record of what you submitted can be helpful if questions arise later. Always make a copy for your own records.

Finally, many applicants neglect to follow up after submitting their request. It’s important to check in to ensure that your form was received and is being processed. A simple follow-up can keep the process moving smoothly.

Avoiding these common mistakes can help streamline your reasonable accommodation request. Take your time, read the form carefully, and ensure all information is complete and accurate.

Documents used along the form

The 13661 form is a key document used for requesting reasonable accommodations in the workplace. Alongside this form, several other documents may be required to ensure a comprehensive understanding of the request and its implications. Below are four forms and documents commonly associated with the 13661 form.

Document 12986 – Nondisclosure of GINA Protected Information: This document informs individuals about the Genetic Information Nondiscrimination Act (GINA) and its restrictions on requesting genetic information. It outlines the exceptions to this rule, particularly in relation to the Family and Medical Leave Act and the Rehabilitation Act.
Part III-A – Medical Documentation: Completed by a healthcare practitioner, this section provides necessary medical information to support the reasonable accommodation request. It details the individual’s diagnosis, its impact on major life activities, and the anticipated duration of the condition.
Part II – Deciding Official Documentation: This part is filled out by the Deciding Official to track the accommodation request. It assesses the limitations imposed by the medical condition and whether the requested accommodations will allow the employee to perform essential job functions.
Part IV – Denial of Reasonable Accommodation Request: If the accommodation request is denied, this section documents the reasons for the denial. It is crucial for maintaining transparency and ensuring that the applicant understands the decision-making process.

These documents work together to facilitate a clear understanding of the reasonable accommodation process, ensuring that all parties involved have the necessary information to make informed decisions. Proper completion and submission of these forms help streamline the accommodation process and support employees in need.

Similar forms

The 13661 form is a key document used to request reasonable accommodations in the workplace. It has several counterparts that serve similar purposes in different contexts. Below is a list of eight documents that share similarities with the 13661 form:

ADA Accommodation Request Form: This form is used under the Americans with Disabilities Act (ADA) to request accommodations for employees with disabilities. Like the 13661, it requires detailed information about the employee's condition and the specific accommodations needed.
FMLA Medical Certification Form: This document is utilized when an employee requests leave under the Family and Medical Leave Act (FMLA). It collects medical information to verify the need for leave, similar to how the 13661 gathers medical documentation for accommodation requests.
Workers' Compensation Claim Form: This form is used to report work-related injuries and seek benefits. It requires medical documentation to support the claim, paralleling the medical requirements of the 13661 form.
Return-to-Work Form: After an employee has been on leave, this form is needed to assess their ability to return to work. It often requires medical clearance, much like the medical documentation requested in the 13661.
Job Analysis Form: This document outlines the essential functions of a job. It is used to determine if an employee can perform their job with accommodations, similar to the evaluation process in the 13661.
Disability Verification Form: This form is often required to confirm an individual’s disability status for various benefits. It collects similar medical information to that found in the 13661 form.
Employee Assistance Program (EAP) Referral Form: This form is used to refer employees to counseling or support services. It may require information about the employee's situation, akin to the personal details requested in the 13661.
Health Insurance Claim Form: Used to file claims for medical expenses, this form requires detailed medical information to support the claim, similar to the medical documentation needed for the 13661 form.

Each of these documents plays a vital role in ensuring that employees receive the support and accommodations they need in the workplace. Understanding their similarities can help in navigating the process of requesting reasonable accommodations effectively.

Dos and Don'ts

When filling out Form 13661 for a reasonable accommodation request, there are several important guidelines to keep in mind. Adhering to these can help ensure that your request is processed smoothly and effectively.

Do provide accurate and complete information in all sections of the form.
Do describe your medical condition clearly, including how it affects your job functions.
Do specify the accommodations you are requesting based on your medical condition.
Do include your contact information and preferred method of communication.
Do submit any additional information as an attachment if there is not enough space on the form.
Don't provide any genetic information, as it is prohibited under GINA.
Don't leave any sections blank unless they are not applicable to your situation.
Don't forget to sign and date the form before submission.
Don't submit the form without reviewing it for errors or omissions.
Don't hesitate to ask for assistance if you have questions about the form or the process.

Following these guidelines can help facilitate a smoother process for your reasonable accommodation request. It is essential to provide clear and complete information to avoid delays or misunderstandings.

Misconceptions

Understanding the 13661 form is crucial for both employees and employers. However, several misconceptions about this form can lead to confusion. Below is a list of common misconceptions along with clarifications.

The 13661 form is only for new employees. The form can be used by both applicants and current employees seeking reasonable accommodations.
Medical documentation is optional. Providing medical documentation is necessary to support the accommodation request, especially if the disability is not obvious.
All medical information is required on the form. Only relevant medical information related to the accommodation request needs to be provided.
Submitting the form guarantees approval. Submission does not guarantee that the request will be approved; each request is evaluated on a case-by-case basis.
Employers can request any medical information. Employers can only request documentation that is necessary to evaluate the need for accommodation.
Filling out the form is a one-time process. If additional information is needed or circumstances change, the form may need to be updated or resubmitted.
There is no deadline for submitting the form. Timeliness is important; delays in submission may affect the accommodation process.
All information is kept confidential. While efforts are made to protect privacy, certain information may be shared with relevant parties as required by law.
The form only applies to physical disabilities. The 13661 form is applicable to both physical and mental impairments that limit major life activities.

Addressing these misconceptions can help streamline the reasonable accommodation process and ensure that all parties understand their rights and responsibilities.

Key takeaways

When filling out and using the 13661 form for reasonable accommodation requests, consider the following key takeaways:

Complete All Relevant Sections: Ensure that all parts of the form are filled out accurately. This includes providing personal information, describing the medical condition, and specifying the requested accommodations.
Documentation is Crucial: Medical documentation from a healthcare professional is necessary. This documentation should clearly outline the relationship between the medical condition and the requested accommodations.
Be Aware of Privacy Regulations: Understand that the information provided is protected under the Privacy Act. It may be shared only under specific circumstances, such as legal proceedings or with relevant federal agencies.
Additional Information May Be Attached: If there is insufficient space on the form to provide all necessary details, you may attach additional documentation. This can help ensure that your request is fully understood.
Timely Submission is Important: Submit the completed form promptly to the appropriate Reasonable Accommodation Coordinator. Delays in submission can hinder the accommodation process.