**SUBJECT:** Processing Reasonable Accommodation Requests for Employees
and Applicants with Disabilities

**TO:** All employees

**Purpose of this transmittal memo.** This transmits a new directive
that explains NARA\'s policy and procedures on providing reasonable
accommodations for qualified NARA employees and applicants with
disabilities.

**Background.** Executive Order 13164 requires agencies to establish
procedures for handling requests for reasonable accommodations from NARA
employees and applicants. NARA processes these requests and provides
accommodations within the timeframes in compliance with these
procedures.

**NARA\'s commitment.** NARA is committed to providing reasonable
accommodations to its employees and applicants for employment to ensure
that individuals with disabilities enjoy full access to equal employment
opportunity at NARA.

**Availability of forms.** Two forms are prescribed by this directive --
NA 3043, Confirmation of Reasonable Accommodation Request, and NA 3044,
Disposition of Reasonable Accommodation Request. These forms are
available on NARANET (click on the NARA eForms tab) as Word templates
and from:

-   The EEO Office at 301-837-1550;

-   All EEO Counselors;

-   NHH at 301-837-3710; and

-   AFGE Council 260 (Union) at 301-837-0901.

**Privacy Act system notice and records scheduling.** The Privacy Act
System Notice and the procedures for the retention of these records are
currently being developed.

**Canceled directives.** Interim Guidances 94-453, Reasonable
Accommodation, and 96-101, Sign Language Interpreter Services, are
canceled.

**Questions.** For questions on this directive contact Allison Darnaby,
Diversity Program Manager, EEO and Diversity Programs (NEEO), at
301-837-0295.

JOHN W. CARLIN

Archivist of the United States

Attachment

**SUBJECT:** Processing Reasonable Accommodation Requests for Employees
and Applicants with Disabilities

**303.1 What is the purpose of this directive?**

This directive provides NARA's policy and procedures on providing
reasonable accommodation for qualified employees and applicants with
disabilities so these individuals may enjoy the benefits and privileges
of employment. It:

a\. Provides instructions to NARA employees and applicants who want to
request a reasonable accommodation and to NARA staff who receive,
coordinate, review, process, and approve requests for reasonable
accommodation at NARA.

b\. Establishes criteria for collecting and annually reporting data on
the numbers and types of reasonable accommodation requests received and
processed at NARA.

**303.2 Authority for this directive**

> a\. E.O. 13164 of July 26, 2000, "Requiring Federal Agencies to

Establish Procedures to Facilitate the Provision of Reasonable
Accommodation"

> b\. 29 U.S.C. 791, The Federal Rehabilitation Act of 1973

c\. 29 CFR Part 1614

d\. EEOC's Policy Guidance on E.O. 13164

e\. The Americans with Disabilities Act of 1990

**303.3 Definitions**

a\. **Applicant -** An individual who applies for employment in response
to a posted job announcement.

b\. **Decision maker -** The NARA official who approves or denies the
request. For an:

\(1\) Employee requesting accommodation - The decision maker, in most
cases, is the employee's immediate supervisor. However, when necessary,
any supervisor in that employee's chain of command, or the office
head/staff director may serve as the decision maker.

\(2\) Applicant - The decision maker is the human resources (HR)
specialist in the Human Resources Services Division (NHH) who is
assigned to process the vacancy. NOTE: If an applicant is a NARA
employee and needs an accommodation in connection with applying for a
position, submit the request to the HR specialist listed as point of
contact on the vacancy announcement.

c\. **Essential function** - The fundamental job duties of the
employment position the individual with a disability holds or seeks. Not
every condition of employment is an essential function of the job merely
because it is in a position description. Distinctions must be made
between fundamental job duties and marginal functions of the position.
Whether a particular function is essential is a case-by-case factual
inquiry. Factors to consider whether a job function is "essential"
include:

> \(1\) Whether the position exists specifically to perform that
> function;
>
> \(2\) Whether there are a limited number of other employees available
> among

whom the performance of that job function can be distributed;

> \(3\) Whether the function is highly specialized so that the
> individual in the

position is hired for her or his expertise or based on the ability to
perform the particular function;

> \(4\) The amount of time spent on the job performing the function; and
>
> \(5\) The consequences of not requiring the incumbent to perform the
> function.

d\. **Individual with a disability -** One who:

\(1\) Has a physical or mental impairment that substantially limits one
or more of such person's major life activities (e.g., walking, talking,
hearing, seeing, breathing, and working).

\(2\) Has a record of such an impairment; or

\(3\) Is regarded as having such an impairment.

e\. **Qualified employee or** **applicant** **with a disability -** An
individual with a disability who with or without reasonable
accommodation can perform the essential functions of the employment
position that such an individual holds or seeks.

\(1\) Incumbent employees - Where an employee performs multiple job
duties, if the employee can perform the essential functions of the
position in which the employee is officially assigned, NARA determines
that the employee can perform the essential functions of her or his job.

\(2\) Qualified applicants - They must satisfy the requisite skill,
experience, education, and other job-related requirements of the
position.

f\. **Reasonable accommodation -** Any change in the work environment,
in the way things are customarily done, or in the application process
that enables a person with a disability to enjoy equal employment
opportunities. The three general categories of reasonable accommodation
are changes to:

\(1\) The job application process to permit people with disabilities to
be considered for jobs;

\(2\) Enable people with disabilities to perform the essential functions
of a job; and

\(3\) Give individuals with disabilities equal access to the benefits
and privileges of employment.

> g\. **Request for a reasonable accommodation --** 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. This request does not have to use any special
words, such as "reasonable accommodation," "disability," or
"Rehabilitation Act," and is given in writing. Applicants may make
requests orally at anytime during the application process.

h\. **Undue hardship --** A situation where a specific type of
reasonable accommodation causes significant difficulty or expense. A
determination of undue hardship must be made on a case-by-case basis,
considering factors that include the nature and cost of the reasonable
accommodation needed and the impact of the reasonable accommodation on
the operations of NARA.

**303.4 Responsibilities**

a\. **The Diversity Program Manager (DPM), EEO and Diversity Programs
(NEEO)**, has overall responsibility for administering the NARA-wide
program, including disseminating the NARA policy to all NARA facilities
and supervisors. When appropriate, the DPM advises supervisors and
managers on providing reasonable accommodations. The DPM is responsible
for collecting and maintaining data regarding reasonable accommodations.
The DPM can receive requests for reasonable accommodations from
employees.

b\. **The Human Resources Services Division (NHH)** is responsible for:

\(1\) Accepting requests for accommodation from applicants and providing
accommodations in the application process; and

\(2\) Advising the decision maker and NEEO in providing reasonable

accommodations that involve human resource matters (e.g., changes in
duties, reassignments, leave usage, and performance issues).

c\. **Immediate supervisors, and if necessary, any other supervisor in
the employee's chain of command, and office heads/staff directors** can
receive requests for reasonable accommodation from employees and act as
decision makers.

d\. **Employees, applicants, or their representatives** are responsible
for requesting reasonable accommodations in accordance with this
directive.

### 303.5 When does NARA provide reasonable accommodation?

a\. NARA provides reasonable accommodation on both a temporary and
permanent basis when an:

\(1\) Applicant with a disability needs an accommodation during any part
of the application or hiring process.

\(2\) Employee with a disability needs an accommodation to:

\(a\) Perform the essential functions of the job;

\(b\) Gain access to the workplace; or

\(c\) Enjoy equal benefits and privileges of employment.

b\. See par. 303.26 for reasons when NARA may not provide a reasonable
accommodation.

7.  

8.  **303.6 What are some examples of reasonable accommodations?**

A \"reasonable accommodation\" may include, but is not limited to:

> a\. Making existing facilities used by employees readily accessible to
> and usable by

individuals with disabilities;

> b\. Job restructuring;
>
> c\. Part-time or modified work schedules;
>
> d\. Acquisition or modification of equipment or devices (see subpar.
> 303.9d);
>
> e\. Appropriate adjustment or modifications of examinations, training
> materials or

policies;

> f\. The provision of qualified readers or interpreters;
>
> g\. Other similar accommodations for individuals with disabilities;
> and

h\. Reassignment to a vacant position.

303.7 Who can request a reasonable accommodation under this directive?

Any employee or applicant who has a disability may request reasonable
accommodation. A family member, health professional, or representative
of an employee or applicant may request reasonable accommodation on
behalf of an employee or applicant. A supervisor may also request a
reasonable accommodation on behalf of his or her employee(s) if the
employee is unaware that he or she is entitled to one or cannot request
an accommodation on his or her own.

### 303.8 When may a request for a reasonable accommodation be made?

An employee, applicant, family member, health professional, or
representative may request a reasonable accommodation at any time, even
if the disability has not previously been disclosed.

303.9 How is a request for reasonable accommodation made?

a\. **An employee** or representative of the employee can make a request
for reasonable accommodation orally, in writing (e.g., email), or using
NA Form 3043, Confirmation of Reasonable Accommodation Request.
**However, if a request is made orally, the employee must follow it up
with NA Form 3043.** NA Form 3043 is available on NARANET as a Word
file, or from NEEO, NHH, the Union, and the employee's supervisor.

b\. An applicant can make a request for reasonable accommodation orally
or in writing.

c\. The request does not need to include any special language, such as,
"reasonable accommodation," "Rehabilitation Act," or "disability." The
request can be a simple statement that the employee or applicant
requesting a reasonable accommodation needs an adjustment or change at
work to enjoy the benefits or privileges or employment due to a medical
condition.

d\. **Computer/Electronic Accommodations Program (CAP)** - If an
employee has a request for assistive technology devices and services, he
or she must contact the CAP Point of Contact in the Information
Resources Policy and Projects Division (NHP) to obtain the CAP
Accommodation Request Form. Employees submit the completed form signed
by their supervisor to the CAP Point of Contact (NHP).

303.10 To whom can a request for reasonable accommodation be made?

a\. An employee (or his or her representative), in most cases, makes a
request for reasonable accommodation to his or her immediate supervisor.
However, if necessary, an employee can make a request to any supervisor
in his or her chain of command, the office head/staff director, or the
DPM.

b\. An applicant must make a request for reasonable accommodation to the
NHH staff member listed as point of contact on the vacancy announcement.
If the applicant makes the request to someone other than the specialist
handling the vacancy, this person must immediately forward it to the
proper specialist for action.

303.11 How is a request for reasonable accommodation from an applicant
processed?

Once the NHH staff member listed as point of contact on the vacancy
announcement receives the request from the applicant, the NHH staff
member must complete NA Form 3043 to establish a written record for
reporting purposes. If the applicant makes the request to someone other
than the specialist handling the vacancy, this person must immediately
forward it to the proper specialist for action. There is no requirement
for the applicant to submit a request in writing. The NHH staff member,
as the decision maker, provides the reasonable accommodation, where
appropriate. The NHH staff member then completes NA Form 3044 and
forwards it to NEEO along with the NA Form 3043. NOTE: If an
accommodation is needed after an applicant is selected, forward the
request to the immediate supervisor.

303.12 How does a NARA official handle an initial request for reasonable
accommodation from an employee?

a\. Oral requests - The NARA official receiving the request from the
employee provides the employee (or their representative) with NA Form
3043 for the employee (or their representative) to complete and informs
the employee who should receive the completed form. The NARA official
must date and identify the decision maker on NA Form 3043 and if
necessary, provide instruction and explanation on completing the form.
If an employee asks for assistance in filling out NA Form 3043, the NARA
official receiving the request helps the employee complete the form.

b\. Written requests - The NARA official receiving the written request
or NA Form 3043 either acts as the decision maker and makes a decision
on the request or forwards the request to the appropriate NARA official
who acts as the decision maker. (See para. 303.3b for definition of a
decision maker).

c\. The NARA official informs the employee who the decision maker is and
notifies the decision maker that a request for reasonable accommodation
is forthcoming.

303.13 When does NARA begin processing a request for reasonable
accommodation?

An employee should submit NA Form 3043 immediately or as soon as
possible; however, it is not a prerequisite for NARA to begin processing
the request. (See subpar. 303.23 for specific timeframes.)

303.14 Who can act as the decision maker?

a\. Applicants - The HR specialist responsible for the vacancy
announcement usually acts as the decision maker.

b\. Employees - The decision maker is typically the immediate
supervisor. However, depending on the accommodation requested, any
supervisor in the employee's chain of command or the office head/staff
director can act as the decision maker.

303.15 If the decision maker is not available to handle the request, who
can act as the backup?

a\. Applicants - If the HR specialist listed as point of contact on the
vacancy announcement is not available to receive and process the request
for reasonable accommodation, the team leader or another HR specialist
processes the request.

b\. Employees - If the NARA official identified on NA Form 3043 as the
decision maker is not available, the request may be handled by any
supervisor in the employees' chain of command or office head/staff
director.

c\. Questions - Contact the DPM if there is doubt as to who should
handle the request.

303.16 How does the decision maker handle a request for reasonable
accommodation from an employee?

The decision maker handles the request as follows:

a\. Reviews NA Form 3043 - The decision maker reviews NA Form 3043 with
the employee and/or the representative and forwards a copy to the DPM.
The decision maker and the employee and/or representative discuss the
details for processing the request.

b\. Analyzes the employees' specific job - The decision maker evaluates
the purpose and essential functions of the employees' job.

c\. **Determines** **what type of accommodation is needed -** The
individual requesting the accommodation and decision maker must first
communicate to answer the following questions, to determine what, if
any, accommodation should be provided:

\(1\) What is the specific limitation, problem, or barrier?

\(2\) What are some possible effective accommodations? (See subpar.
303.6.)

d\. **Identifies** **possible accommodations -** The decision maker
should identify possible accommodations.

\(1\) The decision maker is creative in searching for and considering
possible accommodations, including consulting appropriate resources for
assistance.

\(2\) The individual requesting the accommodation also participates in
helping to identify an effective accommodation.

e\. **Makes** **a decision on the** **request**

\(1\) **Grants** **the request -** The decision maker grants the request
when no medical documentation is needed and the accommodation requested
is effective. The decision maker completes NA Form 3044, Disposition of
Reasonable Accommodation Request, and forwards it to the DPM.

\(2\) **Denies** **the request -** The decision maker completes NA Form
3044 and forwards it to the DPM. See subpar. 303.26 for more detailed
information on denials.

303.17 Who can assist the decision maker in handling the request for
reasonable accommodation?

a\. **DPM -** The decision maker is encouraged to seek the advice of the
DPM when processing the requests for reasonable accommodation to ensure
proper handling of the request. The DPM can be helpful in advising the
decision maker on possible options for accommodations.

b\. **NHH** -- An Employee Relations Specialist can advise the decision
maker and NEEO in providing reasonable accommodations that involve human
resource matters (e.g., changes in duties, reassignments, leave usage,
and performance issues).

c\. **The RESOLVE program -** The decision maker and the employee making
the request have the option to use the RESOLVE program to help both
parties work together to provide the most appropriate accommodation.

d\. **Other** **available resources -** The decision maker can use NARA
resources and other resources (such as the Job Accommodations Network
web site, and various disability advocacy groups) to help in the
decision making.

303.18 What medical documentation can be required?

NARA may require only documentation that is needed to establish that a
person has a Section 501 Rehabilitation Act/ADA disability, and that the
disability necessitates a reasonable accommodation. If an individual has
more than one disability, NARA can request information pertaining only
to the disability that requires reasonable accommodation. NARA may
require that the documentation about the disability and the function
limitations come from an appropriate health care or rehabilitation
professional. The appropriate health care professional in any particular
situation depends on the disability and the type of functional
limitation it imposes. In requesting reasonable medical documentation,
NARA must specify what types of information it is seeking regarding the
disability, the functional limitations of the disability, and the need
for reasonable accommodation.

303.19 Is medical documentation always required to make a decision
regarding an accommodation?

No, if the disability is obvious or already known to the decision maker.
The decision maker does not seek any further medical documentation if he
or she has sufficient information and can logically conclude the
employee or applicant has a disability.

303.20 How must NARA handle medical information?

NARA employees are strictly bound to the confidentiality requirements
below. These requirements are in compliance with the Rehabilitation Act.
NARA employees must:

a\. **Keep medical information confidential and medical files separate
from personnel files** **(i.e., Official** **Personnel File, Employee
Performance File, unofficial personnel file).** This requirement
pertains to all medical information, including information about
functional limitations and reasonable accommodation needs that NARA
obtains in connection with a request for reasonable accommodation.
Exceptions to this general rule include case files maintained by NHH.

b\. **Disclose information only as prescribed in this paragraph.**
Divulging information to individuals without a need to know is a
violation of the Privacy Act. If you need to disclose information, you
must inform the recipients of the information about the confidentiality
requirement. You must also inform the individual with the disability of
the disclosure. Disclose information only in the following situations:

\(1\) Inform supervisors and managers who need to know about necessary
restrictions on the work or duties of the employee and about the
necessary accommodation(s), but only disclose medical information if
strictly necessary.

\(2\) Inform first aid and safety personnel, when appropriate, if the
disability might be a factor in the event of a fire, building
evacuation, or require emergency treatment even if you have not
previously disclosed the existence of a disability; and

\(3\) Inform Government officials of information necessary to
investigate NARA's compliance with the Rehabilitation Act.

303.21 Why is it necessary to complete NA Forms 3043 and 3044?

In order for NARA to keep accurate records for annual reporting to the
Equal Employment Opportunity Commission (EEOC), all requests for
accommodation must be documented using the NA Form 3043 and NA Form
3044. The DPM is responsible for maintaining all forms and providing the
EEOC with required statistics and reports.

303.22 Is NA Form 3043 necessary for an accommodation needed on a
repeated basis?

No. NA Form 3043 is only required for the initial request (e.g., the
assistance of a sign language interpreter or reader).

303.23 What are the timeframes for processing a request and providing a
reasonable accommodation?

NARA processes requests for reasonable accommodation and provides
accommodations, where appropriate, as soon as reasonably possible.
However, the time necessary to process the request depends on the nature
of the accommodation requested and whether it is necessary to obtain
supporting information.

a\. If a request for an accommodation requires no supporting medical
documentation and no extenuating circumstances (see subpar. 303.24a.),
the request must be processed and the accommodation provided in no more
than **20 workdays** from the date the decision maker received the
request.

b\. As soon as the decision maker approves a request, the decision maker
immediately notifies the individual. If immediate accommodation is not
possible, the decision maker informs the individual of the projected
timeframe for providing the accommodation in writing (email is
acceptable).

c\. The decision maker must complete NA Form 3044 and submit it to the
DPM within **10 workdays** of the decision.

**303.24 When may a decision maker extend the processing time?**

Decision makers may extend the time for processing only when there are
extenuating circumstances. Extenuating circumstances are factors in
which unforeseen or unavoidable events prevent prompt processing and
delivery of an accommodation. Extenuating circumstances cover limited
situations.

a\. **Examples of extenuating circumstances:**

> \(1\) There is an outstanding initial or follow-up request for medical

documentation, or when NARA's medical professional is evaluating the
medical information.

\(2\) The purchase of equipment may take longer than **15 to 20
workdays**. The equipment may be on back-order, or the vendor cannot
promptly supply the goods or services and another vendor is not promptly
available, or because of requirements of the Federal Acquisition
Regulations.

> \(3\) NARA needs to hire new staff or contract for an accommodation
> that

involves the removal of an architectural barrier.

> \(4\) The employee with a disability needs to try working with
> equipment on a

trial basis to ensure that it is effective before NARA purchases it.

b\. **An example of a situation that is NOT an extenuating circumstance
-** A staff member being unavailable.

**303.25 What actions are taken if the timeframe is extended?**

a\. **Notify the individual with a disability of the delay -** When a
decision maker cannot meet a timeframe, the decision maker must notify
the individual with a disability and the DPM in writing of the delay,
the reason, and the approximate date on which a decision, or provision
of the reasonable accommodation, is expected. Communicate promptly to
the individual any further developments or changes.

b\. **Use temporary measures when an approved accommodation is delayed
-** If there is a delay in providing an approved accommodation, the
decision maker must investigate whether temporary measures can be taken
to assist the employee. NARA decision makers that approve temporary
measures must ensure that they do not take the place of a permanent
accommodation and that all necessary steps to secure the permanent
accommodation are taken. Temporary measures include the following:

\(1\) **A less effective form of accommodation -** For example, there
may be a delay in receiving adaptive equipment for an employee with a
vision disability. During the delay, the supervisor might arrange for
other employees to act as readers. This temporary measure may not be as
effective as the adaptive equipment, but allows the employee to perform
as much of the job as possible until the equipment arrives.

\(2\) **Measures that are beyond what the law requires (i.e., ADA and
Rehabilitation Act) (example: temporary removal of an essential
function)** **if**:

\(a\) They do not interfere with NARA's operations; and

\(b\) The employee is informed that the measures are temporary.

c\. **Provide a temporary accommodation if a determination is pending
receipt or evaluation of medical documentation -** If NARA has not yet
determined that the individual is entitled to an accommodation, the
decision maker notifies the individual in writing that the accommodation
is being provided on a temporary basis pending the decision.

**303.26 When may a request for reasonable accommodation be denied?**

Denials are made on a case-by-case basis. Seek additional information or
clarification when making a decision (see par. 303.17 for a list of
individuals and programs that can assist in the decision making
process.). Reasons for the denial of a request for accommodation may
include the following:

a\. The requested accommodation would not be effective (e.g., denial of
reassignment -- even when providing the accommodation, the employee is
unable to perform the essential function(s) of the position.)

b\. Providing the requested accommodation would result in undue hardship
(see subpar. 303.3h. for definition). Before reaching this determination
the decision maker (with appropriate consultation with NEEO and NHH, as
appropriate), determines whether other effective accommodations exist
that would not impose undue hardship and, therefore, can be provided.

c\. Medical documentation is inadequate to establish that the individual
has a disability and needs an accommodation.

d\. The requested accommodation would require the elimination of an
essential function.

e\. The requested accommodation would require the lowering of a
performance standard (examples: quantity, quality, reliability, etc.)

**303.27 What is the process for denying a request for reasonable
accommodation?**

a\. As soon as the decision maker decides to deny a request for
reasonable accommodation, the decision maker must complete the
appropriate sections on NA Form 3044 and give it to the individual who
requested the accommodation. The decision maker must also submit a copy
of the completed NA Form 3044, along with any other related
documentation to the DPM.

b\. The decision maker writes the explanation for the denial in plain
language, clearly stating the specific reasons for the denial. If the
decision maker has denied a specific requested accommodation, but has
made a counteroffer that the requester does not agree to during the
interactive process, the denial notice must explain both of the
following:

\(1\) The reason for the denial of the original request; and

\(2\) The reason that the counteroffer accommodation would be most
effective.

c\. The actual notice must include reasons for the denial, for example,
why the accommodation would not be effective or cause undue hardship.
(See par. 303.26 for examples of reasons for denying a request.)

d\. The written notice of denial also informs the individual of the
right to an EEO complaint or union grievance procedures. The notice also
explains NARA's procedures available for alternative dispute resolution
(See NARA 320, NARA's Alternative Dispute Resolution (ADR) Program).

303.28 What recourses are available if the request for reasonable
accommodation is denied?

An employee is encouraged to use his or her chain of command in seeking
informal resolution whenever possible. However, requirements governing
the initiation of statutory and collective bargaining claims remain
unchanged. Individuals can choose to pursue the following statutory or
collective bargaining remedies for denial of reasonable accommodation:

a\. For an EEO complaint, contact an EEO counselor in NEEO within 45
days from the date of receipt of the written notice of denial. If a
member of NEEO has been involved in the processing of the request for
reasonable accommodation, that staff member must excuse

him or herself from any involvement in the processing of an EEO
counseling contact or complaint in connection with that request.

b\. For a grievance under the NARA Collective Bargaining Agreement, file
a written grievance in accordance with the provisions set forth in the
NARA Collective Bargaining Agreement.

303.29 Does NARA keep an official record of all requests?

The DPM maintains all official records created or received during the
processing of a request for reasonable accommodation. The DPM responds
to all requests for disclosure of records. Decision makers must forward
all documentation to the DPM as prescribed in paragraphs 303.16.
However, decision makers may retain copies of all documentation for
their own business purposes.

303.30 How long should records be kept?

Until these records are scheduled, all records, including electronic
copies of emails and word processing files, created or received during
the reasonable accommodation request process must not be destroyed. This
includes records retained by decision makers. This prohibition will
continue until the Archivist approves the disposition of the records. To
the extent that these records are accessible by personal identifiers,
they must be maintained in accordance with the Privacy Act.

**303.31 Where can I find additional relevant resource material on
providing a reasonable accommodation?**

Contact the DPM for a list of select reasonable accommodation resources
or visit the U.S. Equal Employment Opportunity Commission web site.

+----------------+-----+-----------+-------+--------------------------+
| ![](med        |     |           |       |                          |
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| ation Request  |     |           |       |                          |
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| **1.           |     | **2.      |       | **3. REQUESTER'S         |
| REQUESTER'S    |     | ORG       |       | TELEPHONE NO.**          |
| NAME**         |     | ANIZATION |       |                          |
|                |     | CODE**    |       |                          |
+----------------+-----+-----------+-------+--------------------------+
| **4. TODAY'S   | *   |           | **6.  |                          |
| DATE**         | *5. |           | NARA  |                          |
|                | D   |           | OFF   |                          |
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|                | OF  |           | RECE  |                          |
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|                | T** |           | EST** |                          |
+----------------+-----+-----------+-------+--------------------------+
| **7. NARA      |     |           | **8.  |                          |
| DECISION       |     |           | DEC   |                          |
| MAKER/ORG      |     |           | ISION |                          |
| CODE**         |     |           | MA    |                          |
|                |     |           | KER'S |                          |
|                |     |           | TELE  |                          |
|                |     |           | PHONE |                          |
|                |     |           | NO.** |                          |
+----------------+-----+-----------+-------+--------------------------+
| **9.           |     |           |       |                          |
| ACCOMMODATION  |     |           |       |                          |
| REQUESTED**    |     |           |       |                          |
| *(Be as        |     |           |       |                          |
| specific as    |     |           |       |                          |
| possible,      |     |           |       |                          |
| \[e.g.,        |     |           |       |                          |
| adaptive       |     |           |       |                          |
| equipment,     |     |           |       |                          |
| request for an |     |           |       |                          |
| in             |     |           |       |                          |
| terpreter\].)* |     |           |       |                          |
| See NARA 303,  |     |           |       |                          |
| Processing     |     |           |       |                          |
| Reasonable     |     |           |       |                          |
| Accommodation  |     |           |       |                          |
| Requests for   |     |           |       |                          |
| Employees and  |     |           |       |                          |
| Applicants     |     |           |       |                          |
| with           |     |           |       |                          |
| Disabilities   |     |           |       |                          |
+----------------+-----+-----------+-------+--------------------------+
| **10. REASON   |     |           |       |                          |
| FOR REQUEST**  |     |           |       |                          |
+----------------+-----+-----------+-------+--------------------------+
| **11. IF       |     |           |       |                          |
| ACCOMMODATION  |     |           |       |                          |
| IS             |     |           |       |                          |
| T              |     |           |       |                          |
| IME-SENSITIVE, |     |           |       |                          |
| PLEASE         |     |           |       |                          |
| EXPLAIN**      |     |           |       |                          |
|                |     |           |       |                          |
| **-Return      |     |           |       |                          |
| completed form |     |           |       |                          |
| to: NEEO,      |     |           |       |                          |
| Diversity      |     |           |       |                          |
| Program        |     |           |       |                          |
| Manager-**     |     |           |       |                          |
+----------------+-----+-----------+-------+--------------------------+

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA 3043 (3-03)

+------------------+---+-------------------+---+-----------------------+
| ![](m            |   |                   |   |                       |
| edia/image1.png) |   |                   |   |                       |
|                  |   |                   |   |                       |
| #                |   |                   |   |                       |
| Disposition of R |   |                   |   |                       |
| easonable Accomm |   |                   |   |                       |
| odation Request  |   |                   |   |                       |
+------------------+---+-------------------+---+-----------------------+
| **1. REQUESTER'S |   | **2. ORGANIZATION | * |                       |
| NAME**           |   | CODE**            | * |                       |
|                  |   |                   | 3 |                       |
|                  |   |                   | . |                       |
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|                  |   |                   | R |                       |
|                  |   |                   | * |                       |
|                  |   |                   | * |                       |
+------------------+---+-------------------+---+-----------------------+
| **4. DATE OF     | * |                   |   | **6. DATE REQUEST     |
| REQUEST**        | * |                   |   | GRANTED OR DENIED**   |
|                  | 5 |                   |   |                       |
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|                  | * |                   |   |                       |
|                  | * |                   |   |                       |
+------------------+---+-------------------+---+-----------------------+
| **7. TYPE(S) OF  |   |                   |   |                       |
| REASONABLE       |   |                   |   |                       |
| ACCOMMODATION    |   |                   |   |                       |
| REQUESTED**      |   |                   |   |                       |
+------------------+---+-------------------+---+-----------------------+
| **8. TYPE OF     |   |                   |   |                       |
| REASONABLE       |   |                   |   |                       |
| ACCOMMODATION    |   |                   |   |                       |
| GRANTED**        |   |                   |   |                       |
+------------------+---+-------------------+---+-----------------------+
| **9. REASON FOR  |   |                   |   |                       |
| DENIAL: *(more   |   |                   |   |                       |
| than one box may |   |                   |   |                       |
| be checked)***   |   |                   |   |                       |
|                  |   |                   |   |                       |
| **Accommodation  |   |                   |   |                       |
| ineffective**    |   |                   |   |                       |
|                  |   |                   |   |                       |
| **Accommodation  |   |                   |   |                       |
| would cause      |   |                   |   |                       |
| undue hardship** |   |                   |   |                       |
|                  |   |                   |   |                       |
| **Medical        |   |                   |   |                       |
| documentation    |   |                   |   |                       |
| inadequate**     |   |                   |   |                       |
|                  |   |                   |   |                       |
| **Accommodation  |   |                   |   |                       |
| would require    |   |                   |   |                       |
| removal of an    |   |                   |   |                       |
| essential        |   |                   |   |                       |
| function**       |   |                   |   |                       |
|                  |   |                   |   |                       |
| **Accommodation  |   |                   |   |                       |
| would require    |   |                   |   |                       |
| lowering of      |   |                   |   |                       |
| performance or   |   |                   |   |                       |
| production       |   |                   |   |                       |
| standard**       |   |                   |   |                       |
|                  |   |                   |   |                       |
| **Other (Please  |   |                   |   |                       |
| identify)        |   |                   |   |                       |
| \_\_\_\_\_\_\_\_ |   |                   |   |                       |
| \_\_\_\_\_\_\_\_ |   |                   |   |                       |
| \_\_\_\_\_\_\_\_ |   |                   |   |                       |
| \_\_\_\_\_\_\_\_ |   |                   |   |                       |
| \_\_\_\_\_\_\_\_ |   |                   |   |                       |
| \_\_\_\_\_\_\_** |   |                   |   |                       |
+------------------+---+-------------------+---+-----------------------+
| **10. DETAILED   |   |                   |   |                       |
| REASON(S) FOR    |   |                   |   |                       |
| THE DENIAL       |   |                   |   |                       |
| *(Must be        |   |                   |   |                       |
| specific.        |   |                   |   |                       |
| \[e.g., why      |   |                   |   |                       |
| accommodation is |   |                   |   |                       |
| ineffective or   |   |                   |   |                       |
| causes undue     |   |                   |   |                       |
| hardship\].)***  |   |                   |   |                       |
|                  |   |                   |   |                       |
| *Note: If the    |   |                   |   |                       |
| individual       |   |                   |   |                       |
| wishes to        |   |                   |   |                       |
| request          |   |                   |   |                       |
| reconsideration  |   |                   |   |                       |
| of this          |   |                   |   |                       |
| decision, file   |   |                   |   |                       |
| an EEO complaint |   |                   |   |                       |
| or union         |   |                   |   |                       |
| grievance, he or |   |                   |   |                       |
| she should refer |   |                   |   |                       |
| to the           |   |                   |   |                       |
| procedures       |   |                   |   |                       |
| outlined in NARA |   |                   |   |                       |
| 303, Processing  |   |                   |   |                       |
| Reasonable       |   |                   |   |                       |
| Accommodation    |   |                   |   |                       |
| Requests for     |   |                   |   |                       |
| Employees and    |   |                   |   |                       |
| Applicants with  |   |                   |   |                       |
| Disabilities.*   |   |                   |   |                       |
|                  |   |                   |   |                       |
| #                |   |                   |   |                       |
| #### Send a copy |   |                   |   |                       |
|  of completed fo |   |                   |   |                       |
| rm to: Requester |   |                   |   |                       |
|                  |   |                   |   |                       |
| **-Return        |   |                   |   |                       |
| completed form   |   |                   |   |                       |
| to: NEEO,        |   |                   |   |                       |
| Diversity        |   |                   |   |                       |
| Program          |   |                   |   |                       |
| Manager-**       |   |                   |   |                       |
+------------------+---+-------------------+---+-----------------------+

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA 3044 (3-03)