Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1

Name:
Employee ID:

OMB Control Number 1250-0005
Expires 04/30/2026

Date:(if applicable)
Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified
people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says wemust measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disabilityor have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who
makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you
want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance
Programs (OFCCP) website at www.dol.gov/ofccp.
How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had
such a condition, you are a person with a disability. Disabilities include, but are not limited to:• Alcohol or other substance use •disorder (not currently usingdrugs illegally)• Autoimmune disorder, forexample, lupus, fibromyalgia, •rheumatoid arthritis, HIV/AIDS •• Blind or low vision• Cancer (past or present)•• Cardiovascular or heart•
disease• Celiac disease• Cerebral palsy•• Deaf or serious difficulty•hearing• Diabetes•
Disfigurement, for example,
disfigurement caused by burns,wounds, accidents, or congenital
disorders•
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example,
Crohn's Disease, irritable bowel
syndrome
Intellectual or developmental disability •Mental health conditions, for example,•depression, bipolar disorder, anxiety
disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the ••use of a wheelchair, scooter, walker,
leg brace(s) and/or other supports

Nervous system condition, for example,
migraine headaches, Parkinson’s
disease, multiple sclerosis (MS)Neurodivergence, for example,
attention-deficit/hyperactivity disorder(ADHD), autism spectrum disorder,
dyslexia, dyspraxia, other learning
disabilities
Partial or complete paralysis (anycause)
Pulmonary or respiratory conditions, forexample, tuberculosis, asthma,emphysema
Short stature (dwarfism)
Traumatic brain injury

Please check one of the boxes below:
Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respondto a collection of information unless such collection displays a valid OMB control number. This survey should take about 5
minutes to complete.
For Employer Use Only
Employers may modify this section of the form as needed for recordkeeping purposes.
For example:
Job Title:
Date of Hire: