Page 1 of 14

USAG-Miami EEO SOP 

Reasonable Accommodation Process 

Table of Contents

 Reasonable Accommodation Process....................................................................... 2

Purpose ........................................................................................................................................ 2

References ................................................................................................................................... 2

Attachments ................................................................................................................................. 2

Background .................................................................................................................................. 2

Roles & Responsibilities ............................................................................................................. 3

Process Flow Template ................................................................................................................ 5

Notice of request .......................................................................................................................... 6

Intake ........................................................................................................................................... 6

Data Gathering ............................................................................................................................. 8

Employee input ............................................................................................................................ 8

Assessment .................................................................................................................................. 8

Decision ..................................................................................................................................... 12

Review and analysis .................................................................................................................. 13

Important administrative requirements ...................................................................................... 13

Comment on the role of the Health Clinic ................................................................................. 14

DD Form 2870, Authorization for Disclosure of Medical or Dental Information

Appendix B – Confirmation of Request for Reasonable Accommodation

Appendix C – Reasonable Accommodation Request Resouces 

Appendix E – Denial of Accommodation Request

Appendix F – Reasonable Accommodation Information Report
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Reasonable Accommodation Process

Purpose This SOP documents the roles and responsibilities of U.S. Army GarrisonMiami managers and staff in responding to an employee request for 

reasonable accommodation and to establish a template for processing the 

request.

References The primary references are:

• AR 690-12, Equal Employment Opportunity and Diversity, Appendix C, dated 

12 December 2019

• The Rehabilitation Act of 1973, as amended, 29 USC 791 et seq.

• The Americans with Disabilities Amendments Act of 2008 (ADAA), Pub. L. 

No. 110-325

• 29 CFR Part 1630 – Regulations to Implement the Equal Employment 

Provisions of the American with Disability Act 

• SAMR-ZA Memorandum dated 17 March 2009, subject: US Army Procedures 

for Providing Reasonable Accommodation for Individuals with Disabilities

Attachments This SOP references to several forms and documents. The following forms 

and documents are attached as an appendix to this SOP:

• Encl. 1 – DD Form 2870, Authorization for Disclosure of Medical or Dental 

Information

• Encl. 2 – Appendix B – Confirmation of Request for Reasonable 

Accommodation

• Encl. 3 – Appendix C – Reasonable Accommodation Request Resource

• Encl. 4 – Appendix E – Denial of Reasonable Accommodation Request

• Encl. 5 – Appendix F – Reasonable Accommodation Information Report

Background With the passage of the ADA and the promulgation of a standard Army 

procedure for addressing requests for accommodation, USAG-Miami must 

document a standard process so that employee needs can be met in a timely 

and responsive manner in accordance with Army policy.

Note: The participants recognize that needs for accommodation arise in 

various ways and that no single procedure can address every situation. The 

participants will adapt the following template to each individual situation so 

that requests are resolved timely after meaningful dialog with the requester.
Page 3 of 14

Reasonable Accommodation Process, Continued

Roles & 

Responsibilities

The key roles and responsibilities for processing a request for reasonable 

accommodation (RA) are:

Role Responsibility

Supervisor • Serves as decision-maker on requests for reasonable

accommodation

• Receives requests & supporting documentation

• Engages in interactive dialog with employee

• Makes temporary assignment of employee pending 

resolution of accommodation request – if applicable

• Coordinates with CPAC, Legal, Disability Program 

Manager, EEO, Health Clinic, LMER

• Issues written decision on reasonable accommodation

issues

Employee who 

requests 

reasonable

accommodation

• Notifies his/her immediate supervisor of a desire for a 

reasonable accommodation

• Completes Confirmation of Request for Reasonable 

Accommodation form and returns it to his/her 

supervisor - Appendix B – Encl. 2

• Completes DD Form 2870, Authorization for 

Disclosure of Medical or Dental Information and 

returns it to his/her supervisor – Encl. 1

• Responds promptly and fully to request for clarifying 

medical information, especially with regard to 

limitations and their extent and duration

• Discusses his/her request with his/her supervisor at 

various times while the request is pending to clarify 

needs and opportunities

Disability 

Program 

Manager/EEO 

Manager

• Serves as resource for supervisors on potential 

reasonable accommodations

• In conjunction with Legal Office & CPAC provide 

supervisor with recommended courses of action

• Uploads reasonable accommodation request onto 

MD715 portal and tracks process IAW timeline

• Assesses USAG-Miami reasonable accommodation 

program

• Facilitates the reasonable accommodation process
Page 4 of 14

Reasonable Accommodation Process, Continued

Roles & 

Responsibilities

(continued)

Role Responsibility

Legal Counsel • Provides legal advice to supervisors and staff 

throughout reasonable accommodation process

• Provides the Disability Program Manager legal advice 

upon request whenever s/he makes recommendation to 

supervisor

• Provides legal advice to the Disability Program 

Manager and supervisor when requesting medical 

information

• Reviews all denials of reasonable accommodation

Appendix F – Encl 4

LMER 

Representative /

HR Specialist 

• Reviews vacancy listings to determine presence of 

funded vacancies for reassignment

• Coordinates with other CPAC Staffing Specialists to 

ascertain employee qualification for vacant positions

• Coordinates with supervisor, Disability Program 

Manager, other staff to facilitate reassignment where 

possible

• For accommodation for work-related injuries, 

facilitates implementation of USAG-Miami policy on 

placement

HR Specialist 

(Employee and 

Labor 

Relations)

• Provides personnel advice to supervisors and staff 

throughout accommodation process

• Facilitates advice to the Disability Program Manager, 

Supervisor, on job requirements and qualifications

• Advises supervisor on decisions related to 

accommodation and necessary /proper personnel 

actions 

SOUTHCOM 

Health Clinic 

• Reviews medical documentation when an employee 

returns to duty - (Fit for Duty)

• Reviews medical documents when an employee seeks 

to assume a new duty position

• Advises supervisors if they should have a question on 

whether a particular work assignment violates a 

medical limitations imposed by a health care 

professional

Safety Office • Provides advice on applicability of equipment, 

ergonomic improvements, or engineering controls to 

resolve requests for accommodation 
Page 5 of 14

Reasonable Accommodation Process, Continued

Process Flow

Template

The following table summarizes the process flow for processing a request for 

reasonable accommodation. Every request for accommodation must go 

through each stage.

Stage Description

Notice of RA 

request

The process of putting supervision on notice that a 

reasonable accommodation is needed or requested.

Intake

The process of documenting a request for reasonable 

accommodation and ensure the request is tracked to 

completion.

Data 

Gathering

The process of compiling medical and other information 

needed to make a decision on reasonable accommodation 

alternatives.

Employee 

Input

The process that ensures there is interactive dialog 

between the requester and his/her supervisor on 

reasonable accommodation alternatives.

Assessment The process of considering alternatives and whether one 

or more alternatives should be adopted.

Decision The process of reaching a decision (approve/deny)

reasonable accommodation on an employee's request.

Review and 

analysis

The process of reviewing the application of rules and 

policies to requests so that process and decision-making 

improvements can be made.

The following blocks provide guidance and direction on each of these stages:
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Reasonable Accommodation Process, Continued

Notice of 

request

It is the employee’s obligation to put the USAG-Miami thru employee’s 

immediate supervisor or Director on notice that s/he needs or is requesting an 

accommodation. Notice can take several forms:

• May be an oral or written request - Encl 2

• May be a request for an adjustment or change at work related to a medical 

condition

• May be made by a family member, health care professional, or other 

representative on behalf of the employee

• Does not require use of words “reasonable accommodation” or “disability” 

or citation to the Rehabilitation Act

Intake The requester’s supervisor and the Disability Program Manager need to 

ensure the employee request is logged in and tracked.

If ... Then ...

The requester or someone on behalf 

of the requester (to include another 

management official) contacts the 

supervisor AND the request can be 

immediately granted

The supervisor will:

• Grant the accommodation – Encl. 5

• Provide the Confirmation of 

Request for Reasonable 

Accommodation form (Appendix 

B) – Encl. 2 to the employee, who 

will complete it and return it to the 

supervisor

• Provide the completed 

Confirmation of Request for 

Reasonable Accommodation form 

(Appendix B) Encl. 2, to the 

Disability Program Manager 

• Provide the Disability Program 

Manager with a memorandum that 

explains the accommodation 

provided

• Complete all paperwork required by 

the Disability Program Manager to 

close the file
Page 7 of 14

Reasonable Accommodation Process, Continued

Intake

(continued)

If ... Then ...

The requester or someone on behalf 

of the requester (to include another 

management official) contacts the 

supervisor AND the request cannot 

be immediately granted

The supervisor will:

• Provide the requester with the 

Confirmation of Request for 

Reasonable Accommodation form

(Appendix B) Encl. 2 and DD Form 

2870 (Encl. 1); the requester will 

return the completed forms to his/her 

supervisor

• Notify the Disability Program 

Manager and discuss the request

• Begin the data gathering, employee 

input, and assessment processes

• Provide a copy of the completed 

Confirmation of Request for 

Reasonable Accommodation 

(Appendix B) Encl. 2 and DD Form 

2870 (Encl. 1) to the Disability 

Program Manager

The requester contacts a 

management official other than 

his/her supervisor or the Disability 

Program Manager

The management official will notify 

the requester’s supervisor and the 

Disability Program Manager

The requester, the supervisor, or 

another management official 

contacts the Disability Program 

Manager

The Disability Program Manager will:

• Ensure the requester is provided the 

Confirmation of Request for RA

form (Appendix B) Encl. 2 and DD 

Form 2870 (Encl. 1); the requester 

will return the completed forms to 

the supervisor

• Provide to the supervisor the RA

Information Report (Appendix F); 

the supervisor will compete the form 

and return it to the Disability 

Program Manager – Encl. 5

• Discuss the request with the 

supervisor

• Upon receipt of the completed 

Confirmation of Request for 

Reasonable Accommodation form

(Appendix B), assign a tracking 

number. Encl. 2
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Reasonable Accommodation Process, Continued

Data Gathering A supervisor must have sufficient documentation to make an informed 

decision about accommodation. A document is sufficient if it provides 

information on the scope, severity, duration of the condition and provides 

reasonably specific limitations that apply to the employee’s job. The 

following actions will ensure adequate data is obtained:

• Review the Confirmation of Request for Reasonable Accommodation form 

(Appendix B) and any supporting documents submitted by the requester or 

on his/her behalf – Encl. 2

• Discuss the sufficiency of documentation with the Disability Program 

Manager, MER, and Legal

• If there is insufficient documentation, provide the employee with a written 

request for information to determine limitations and possible 

accommodation

Employee input The Rehabilitation Act requires interactive dialog between the employee and 

the supervisor (Appendix C) to ensure non-obvious accommodations are 

considered. Encl. 3 - Supervisors will ensure the following communication 

efforts are made:

• Discuss the request with the employee and his/her representative, if 

applicable (see MER assistance if needed). 

• Do not be argumentative – seek to clarify the request, especially with regard 

to limitations.

• Be sure to ask what specific job changes the employee thinks would resolve 

the issues.

• Document the conversation with a Memorandum for Record.

• Document all follow-up meetings or requests for documentation.

Assessment The supervisor will consider all relevant information and will staff his/her 

decision on offering reasonable accommodation. At minimum, supervisors 

will ensure the following steps are followed:

Step Action

1 Ensure the employee’s limitations (scope, severity, duration) are 

clearly known; if they are not, apply the “Data Gathering” 

actions noted above
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Reasonable Accommodation Process, Continued

Assessment

(continued)

Step Action

2 Determine if the employee can perform the essential functions of 

his/her current position.

Note: “Essential Functions” are the fundamental job duties of the 

employment position in question. A function is “essential” if the 

reason the position to exist is to perform that function; there are 

a limited number of other employees available among whom the 

performance of that job function could be distributed; or the 

function is highly specialized so the incumbent is hired based on 

experience or ability to perform it. 

If Then

The employee can 

perform the 

essential functions 

of their position

No accommodation is required, but adjust 

job duties so as to not violate medical 

restrictions 

The employee 

cannot perform 

the essential 

functions of their 

position

Temporarily assign duties (if applicable) 

that do not violate medical restrictions 

and work with the affected Director to: 

• Look for job re-engineering or 

assistive technology to address the 

medical limitations

• Discuss the alternatives with the 

employee

• Discuss the alternatives with the 

Disability Program Manager and obtain 

his/her advice

• Discuss the alternatives with the LMER 

and Legal representatives, obtain their 

advice.

• If re-engineering and/or assistive 

technology allow the employee to 

perform his/her essential functions 

without undue hardship, make changes

• If those do not resolve the matter, go to 

Step 3

Note: Supervisors should work closely with staff, to include the 

Safety Office, to ensure engineering alternatives are considered.
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Reasonable Accommodation Process, Continued

Assessment

(continued)

Step Action

3 Consider reassignment. Reassignment is the accommodation of 

last resort, and it should be offered only if the following 

procedures are followed:

Step Action

A The Supervisor will forward the request along with all 

supporting documentation to his/her Director, who 

will seek positions in his/her organization to which 

the requesting employee might be reassigned.

B The Director will forward a Memorandum Requesting 

Selective Placement Assistance along with all 

supporting documents and any position identified for 

reassignment to the LMER Representative. 

C Appropriate Staffing and Classification Specialists, 

will search for funded vacancies for which the 

employee seeking accommodation qualifies.

If Then

The employee 

does not have 

a workers’ 

compensation 

claim

The LMER Representative will:

• Document the position search

• Document the qualification 

determination

• Identify positions to which the 

employee might be reassigned; 

if none, so state

• Provide his/her findings and 

recommendation to the 

supervisor (go to Step 4)

The employee 

has a workers’ 

compensation 

claim

The LMER Representative will

complete the steps above and will 

continue to search for placement; 

the supervisor and Disability 

Program Manager will be 

updated on a regular basis
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Reasonable Accommodation Process, Continued

Assessment

(continued)

Step Action

4 The supervisor will:

• Discuss the accommodation or placement options with the 

employee and document the conversation with a Memorandum 

for Record, or

• Provide the employee with a letter that outlines the 

accommodation or placement options and provide the 

employee with an opportunity to provide input and comment
Page 12 of 14

Reasonable Accommodation Process, Continued

Decision Army policy requires the following:

If ... Then ...

The decision is to provide some 

form of accommodation

The supervisor will

• Immediately communicate the 

decision orally or in writing

• Follow up any oral notification 

with a written decision

• Complete the Reasonable 

Accommodation Information 

Report (Appendix F) and provide 

it to the Disability Program 

Manager – Encl. 5

The decision is to not provide some 

form of accommodation

The supervisor will

• Consult with the Disability 

Program Manager and obtain 

his/her advice

• Provide the Legal Office with the 

draft decision, justification, and 

supporting documents for review

• Upon receipt of advice from the 

Legal Office, communicate the 

decision orally or in writing 

• Complete the Denial of 

Accommodation Request Form

(Appendix E) and provide it to the 

employee. Encl. 4

• Complete the Reasonable 

Accommodation Information 

Report (Appendix F) and provide

it along with ALL supporting 

documentation to the Disability 

Program Manager. Encl. 5

• Contact the LMER Cell to 

determine the proper course of 

action

Note: As a matter of USAG-Miami policy, employees on Workers 

Compensation will normally not be removed/terminated absent unusual 

circumstances, and placement efforts will be a continuing effort. 

EMPLOYEES WITH COMPENSATION CLAIMS WILL BE TEMPORARILY 

ACCOMMODATED PENDING COMPLETION OF THE DEPARTMENT 

OF LABOR (DOL) PROCESS.
Page 13 of 14

Reasonable Accommodation Process, Continued

Review and 

analysis

The Disability Program Manager is responsible for reviewing the 

accommodation process and assessing it for improvements. The Disability 

Program Manager will:

• Provide required information for completion of the MD 715 report as 

required by the DA policy

• Provide required information for on-site EEO Program reviews as required 

by the DA policy

• Review cases and processes to provide advice to leadership and staff 

regarding process improvements

Important 

administrative 

requirements

The foregoing process will ensure the legal requirements for reasonable 

accommodation are met. In order to comply with Army and local policy, the 

following requirements are noted:

• DA policy requires that USAG-Miami will process requests for reasonable 

accommodation “as soon as reasonably possible.” 

• Absent unusual circumstances, a request should be granted, denied, or 

modified within 30 business days from the date the request is received by 

the supervisor. The 30 business days are tolled for periods where 

additional documentation is being requested.

• Temporary or provisional accommodations may be required during the 

period of time a request is being process. Supervisors are to coordinate with

their Director and LMER, Disability Program Manager, Equal Employment 

opportunity Manager, and Legal to ensure a proper temporary or provisional 

decision are made.

• The EEO Office must establish a system of record to track processing of 

requests for reasonable accommodation and maintain records related to 

requests for accommodation and disposition of those requests, including 

supporting medical documentation.
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Reasonable Accommodation Process, Continued

Comment on 

the role of the 

Health Clinic

With respect to the foregoing process, the SOUTHCOM Health Clinic

(SCHC) is a staff advisory resource, to be consulted by supervisors, 

managers, and staff to assist in understanding medical aspects of 

accommodation. The following observations are noted:

• The decision to make an accommodation is a management determination, 

not a medical determination

• Nothing in this process map limits the ability or availability of the Medical 

Director to advise supervisors and staff in the accommodation process

• Although supervisors may review relevant portions of an employee’s 

medical record at the SCHC, the SCHC is not a treatment facility and 

supervisors should obtain medical-related documentation from the 

employee, especially pertaining to job-related limitations

• Supervisors should consult the Medical Director if they have a question 

about whether a particular work assignment violates a medical limitation.

• All situations referred to the SCHC will result in written documentation, 

typically a Health Clinic Pass or a Memorandum depending on the scope of 

the clinic visit. That documentation must be made a part of the 

management file.

 Approved this 15 day of October, 2020

 Cesar Vargas

 Equal Employment Opportunity - Manager

 United States Army Garrison-Miami

Encl’s:

Encl. 1 – DD Form 2870, Authorization for Disclosure of Medical or Dental Information

Encl. 2 – Appendix B, Request for Reasonable Accommodation

Encl. 3 – Appendix C, Reasonable Accommodation Request Resources

Encl. 4 – Appendix E, Denial of Reasonable Accommodation

Encl. 5 – Appendix F, Reasonable Accommodation Information Report
AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION

In accordance with the Privacy Act of 1974 (Public Law 93-579), the notice informs you of the purpose of the form and how

it will be used. Please read it carefully.

AUTHORITY: Public Law 104-191; E.O. 9397 (SSAN); DoD 6025.18-R.

PRINCIPAL PURPOSE(S): This form is to provide the Military Treatment Facility/Dental Treatment Facility/TRICARE Health Plan

with a means to request the use and/or disclosure of an individual's protected health information.

ROUTINE USE(S): To any third party or the individual upon authorization for the disclosure from the individual for: personal

use; insurance; continued medical care; school; legal; retirement/separation; or other reasons.

DISCLOSURE: Voluntary. Failure to sign the authorization form will result in the non-release of the protected health

information.

This form will not be used for the authorization to disclose alcohol or drug abuse patient information from medical records or

for authorization to disclose information from records of an alcohol or drug abuse treatment program. In addition, any use as

an authorization to use or disclose psychotherapy notes may not be combined with another authorization except one to use or

disclose psychotherapy notes.

PRIVACY ACT STATEMENT

SECTION I - PATIENT DATA

1. NAME (Last, First, Middle Initial) 2. DATE OF BIRTH (YYYYMMDD) 3. SOCIAL SECURITY NUMBER

4. PERIOD OF TREATMENT: FROM - TO (YYYYMMDD) 5. TYPE OF TREATMENT (X one)

OUTPATIENT INPATIENT BOTH

SECTION II - DISCLOSURE

6. I AUTHORIZE

a. NAME OF PERSON OR ORGANIZATION TO RECEIVE MY 

MEDICAL INFORMATION

b. ADDRESS (Street, City, State and ZIP Code)

c. TELEPHONE (Include Area Code) d. FAX (Include Area Code)

9. AUTHORIZATION START DATE (YYYYMMDD) 10. AUTHORIZATION EXPIRATION

DATE (YYYYMMDD)

8. INFORMATION TO BE RELEASED

SECTION III - RELEASE AUTHORIZATION

I understand that:

a. I have the right to revoke this authorization at any time. My revocation must be in writing and provided to the facility

where my medical records are kept or to the TMA Privacy Officer if this is an authorization for information possessed by the

TRICARE Health Plan rather than an MTF or DTF. I am aware that if I later revoke this authorization, the person(s) I herein

name will have used and/or disclosed my protected information on the basis of this authorization.

b. If I authorize my protected health information to be disclosed to someone who is not required to comply with federal

privacy protection regulations, then such information may be re-disclosed and would no longer be protected.

c. I have a right to inspect and receive a copy of my own protected health information to be used or disclosed, in accordance

with the requirements of the federal privacy protection regulations found in the Privacy Act and 45 CFR 164.524.

d. The Military Health System (which includes the TRICARE Health Plan) may not condition treatment in MTFs/DTFs, payment

by the TRICARE Health Plan, enrollment in the TRICARE Health Plan or eligibility for TRICARE Health Plan benefits on failure to

obtain this authorization.

I request and authorize the named provider/treatment facility/TRICARE Health Plan to release the information described above

to the named individual/organization indicated.

11. SIGNATURE OF PATIENT/PARENT/LEGAL REPRESENTATIVE 12. RELATIONSHIP TO PATIENT

(If applicable)

13. DATE (YYYYMMDD)

SECTION IV - FOR STAFF USE ONLY (To be completed only upon receipt of written revocation)

14. X IF APPLICABLE:

AUTHORIZATION

REVOKED

15. REVOCATION COMPLETED BY

17. IMPRINT OF PATIENT IDENTIFICATION PLATE WHEN AVAILABLE

SPONSOR NAME: 

FMP/SPONSOR SSN: 

SPONSOR RANK: 

BRANCH OF SERVICE: 

PHONE NUMBER: 

DD FORM 2870, DEC 2003 Adobe Professional 8.0

16. DATE (YYYYMMDD)

ACTION COMPLETED

7. REASON FOR REQUEST/USE OF MEDICAL INFORMATION (X as applicable)

PERSONAL USE

INSURANCE

CONTINUED MEDICAL CARE

RETIREMENT/SEPARATION

SCHOOL

LEGAL

OTHER (Specify) 

(Name of Facility/TRICARE Health Plan)

 TO RELEASE MY PATIENT INFORMATION TO:

ss
NOTE: This form should be completed by the employee making the reasonable accommodation (RA) request and provided to 

his/her supervisor. An applicant should return the form to any Army employee with whom the applicant has had contact in 

connection with the application process. If third party is completing the form on behalf of the employee or a management 

official is documenting an oral RA request, a copy of the completed form will be provided to the employee to confirm receipt of 

the RA request. Supervisors must provide a copy of this form to the EEO Office or Disability Program Manager, who will assign a 

log number and return a copy of the form to the supervisor.

15

APPENDIX B

CONFIRMATION OF REQUEST FOR REASONABLE ACCOMMODATIONS

1. INDIVIDUAL INFORMATION

Applicant or Employee Name (Last, First, MI): ______________ Phone: _____________________

Pay Plan, Series, Grade: _____________________ Email: ___________________________________

Job Title: ______________________________________ Date of Request: _____________________

Organization: ___________________________________________ UIC: _______________________

Form Completed by: ____________________________ Date Form Completed: _________________

Phone: _________________________________ Email: _____________________________________

2. ACCOMMODATION REQUESTED: (Be as specific as possible, e.g... Sit-n Stand, CPU Reader, 

Interpreter, Telework, FMLA, Weather or Safety Leave, Telework, Alternate Work Scheduled 

The USANEC must approve all special software prior to installation

3. REASON FOR REQUEST: Be cautious “NOT” to provide any sensitive medical information that 

may violate the HIPAA Act of 1996, Public Law 104-191.

If accommodation is time sensitive, please explain:

Provide Form to Supervisor, Supervisor Forward to EEO

4. Supervisor Signature Acknowledge Receipt: ______________________ Date: ____________

5. Docket Number: (EEO Office will assign number) _______________________ Date: _____________
APPENDIX C 

REASONABLE ACCOMMODATION REQUEST RESOURCE

• A discussion between management and an employee as part of the interactive process to discuss or 

clarify the employee’s need for an accommodation or to explore potential accommodations might 

include topics such as the following (as applicable to the particular situation):

• How is the employee’s ability to perform job duties affected by the medical condition?

• Which job duties are affected?

• What suggestions does the employee have for accommodation?

• Is there more than one accommodation that would allow the employee to perform the essential 

functions of the position?

• If a meeting with the employee is needed as part of the interactive process, has the Civilian Personnel 

Advisory Center (CPAC) coordinated with the employee’s bargaining unit representative (if 

applicable)?

• Which, if any, of the accommodations being considered are available? Which are reasonable?

• Is there a need to consult with a resource specializing in rehabilitation and accommodation issues, 

such as the Computer/Electronic Accommodation Program (CAP) officials?

• Is any coordination needed with facilities or fiscal managers?

• Prior to implementing a reasonable accommodation, has the CPAC coordinated with the employee’s 

bargaining unit representative (if applicable)?

• Has the Disability Program Manager been consulted prior to requesting medical information?

• Has the servicing agency attorney/labor counselor conducted a legal review prior to denial of a 

requested accommodation or the particular accommodation requested? 
APPENDIX E 

DENIAL OF REASONABLE ACCOMMODATION REQUEST

Log Number: ____________________

1. Individual Requesting Reasonable Accommodation: ___________________________________. 

 

2. Type(s) of accommodation requested: ______________________________________________. 

3. Request for accommodation denied because (double click to check all that apply) 

Accommodation Would Cause Undue Hardship

Medical Documentation Inadequate

Accommodation Would Require Removal of one or more essential job functions

Other (Please identity) _________________________________________________. 

4. Detailed Reason(s) for the denial of requested accommodation (Must be specific, e.g., why 

accommodation is ineffective or causes undue hardship): _______________________________

_____________________________________________________________________________

_____________________________________________________________________________.

5. If the individual proposed one type of reasonable accommodation which is being denied but 

rejected on offer of a different type of reasonable accommodation, explain both the reasons for 

denial of the requested accommodation and why the chosen accommodation is effective.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________.

6. An individual who disagrees with the denial of an accommodation request is encouraged to 

initiate alternate dispute resolution (ADR) through any applicable ADR process established by the 

Army.

7. If the individual wishes to file an EEO complaint, or pursue Merit Systems Protection Board 

(MSPB) appeal and union grievance procedures (if applicable), s/he must take the following 

steps. The time limits for these steps apply whether or not the individual has initiated ADR:

• For an EEO complaint pursuant to 29 C.F.R. 1614, contact an EEO counselor within the 

Equal Employment Opportunity Office within 45 calendar days from the date of the 

notice of denial of accommodation request, or

• For a collective bargaining claim, file a written grievance in accordance with the 

provisions of the Collective Bargaining Agreement; or

• Initiate an appeal to the MSPB within 30 calendar days of an appealable adverse action 

as defined in 5 C.F.R. § 1201.3.

_______________________________________ ______________________________________ 

 Printed/Typed Name and Date requested Accommodation Denied

 Signature of Deciding Official

_______________________________________ ______________________________________

 Employee Signature Acknowledging Receipt Date of Receipt
22

APPENDIX F

REASONABLE ACCOMMODATION INFORMATION REPORT

To be completed by manager/official who processed the accommodation request. Once completed, submit to local 

Disabilities Program Manager (EEO Office). (Use additional sheet if necessary)

1. Request for Accommodation: (check one):

Approved Denied (Attach copy of written denial memo sent to individual.)

Date reasonable accommodation requested: _____________ (Doc # RA-MIAMI__________)

2. Who received the initial request: _________________________________________________________

3. Date reasonable accommodation request referred to decision maker (i.e., supervisor, Office Director).

____________________________________________________________________________________

4. Name and position of Decision Maker: _____________________________________________________

5. Date request approved or denied: ________________________________________________________

6. Date reasonable accommodation was provided (if different from date approved): _______________

7. If the period outlined in the Reasonable Accommodation Procedures was not met, (30 Days) explain why: 

____________________________________________________________________________________.

8. Job held or desired by individual requesting reasonable accommodation:

• Occupational Series: _________, Grade _______ Directorate ____________

9. Reasonable Accommodation needed for: (Check one) 

Application Process

Performing Job Functions or Accessing the Work Environment

Accessing a Benefit or Privilege of Employment (e.g., attending a training program)

Ergonomic Needs

Other _______________________________________________________________

10. Type(s) of reasonable accommodation requested (e.g., adaptive equipment, staff assistant, telework, 

alternate work scheduled, removal of architectural barrier). ____________________________________

11. Type(s) of reasonable accommodation provided (if different from request). ________________________

_____________________________________________________________________________________

12. From what organization was, adaptive equipment obtained? (If applicable) _______________________

13. Was medical information required to process this request? If yes, explain why? 

_____________________________________________________________________________________

14. Sources of technical assistance, if any consulted in trying to identify possible reasonable accommodations

(e.g., Job Accommodation Network (JAN), Computer/Electronic Accommodation Program (CAP), or 

Disability Program Manager (DPM). _______________________________________________

Submitted to EEO By:

Name: _____________________________________ Organization: _________________

Phone: ________________ Email: __________________________________________

Signature ____________________________________ Date Submitted______________