13661 PDF Template

The 13661 form is a document used to request reasonable accommodations in the workplace for individuals with disabilities. This form facilitates communication between employees, applicants, and decision-makers, ensuring that necessary adjustments are made to support those who need them. If you are ready to start the process, fill out the form by clicking the button below.

Article Guide

The 13661 form serves as a crucial tool for individuals seeking reasonable accommodations in the workplace, particularly within the context of employment with the Internal Revenue Service (IRS). This form is divided into several parts, each designed to facilitate the documentation and evaluation of accommodation requests. Part I requires the applicant, employee, or IRS official to provide essential personal information and details about the medical condition that necessitates the accommodation. It also prompts the individual to describe how their condition impacts their job functions and to specify the type of accommodation they are requesting. Following this, Part II focuses on the Deciding Official's assessment, where they document the impact of the medical condition on job performance and consider alternative accommodations if necessary. Parts III-A and III-B delve into the medical documentation required from healthcare professionals, outlining the need for a diagnosis and the relationship between the medical condition and the requested accommodations. Finally, Part IV addresses the potential denial of a reasonable accommodation request, ensuring that all decisions are formally recorded. Importantly, the form also includes a privacy statement, emphasizing the protection of sensitive information, particularly in relation to genetic data, as mandated by the Genetic Information Nondiscrimination Act (GINA). This comprehensive approach not only streamlines the accommodation process but also safeguards the rights and privacy of individuals with disabilities.

13661 Preview

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

File Properties

Fact Name	Details
Form Purpose	The 13661 form is designed to document requests for reasonable accommodations in the workplace.
Part I	This section is completed by the applicant or employee to outline their accommodation request.
Part II	Deciding Officials complete this part to track the accommodation request and document their decisions.
Medical Documentation	Parts III-A and III-B are filled out by healthcare professionals to provide necessary medical information.
Denial Process	Part IV is used by Deciding Officials to document any denial of the accommodation request.
Privacy Act Statement	The form includes a statement explaining how the collected information will be used and protected.
GINA Compliance	The form adheres to the Genetic Information Nondiscrimination Act, ensuring genetic information is not improperly requested.
FMLA Considerations	Requests under the Family and Medical Leave Act are treated with specific exceptions regarding genetic information.
Legal Basis	This form operates under the Rehabilitation Act, specifically Section 501, which governs reasonable accommodations for disabilities.

Instructions on Utilizing 13661

Filling out Form 13661 is an important step in the process of requesting a reasonable accommodation. This form collects necessary information to support your request and ensures that it is processed effectively. Follow the steps below to complete the form accurately.

Part I: Written Reasonable Accommodation Request
- Enter your last name and first name.
- Provide your occupational SEID, series, and grade.
- Fill in your operating division or function.
- List your contact information, including office phone number, fax number, post of duty, tour of duty/shift, email address, and preferred method/time to contact.
- Complete your mailing address, including address lines, room number, mail stop, city, state, and ZIP code.
- Provide your manager's contact information, including their name, telephone number, and email address.
- Describe your medical condition requiring accommodation.
- Explain how your medical condition limits your ability to perform your current duties, participate in the application process, or access a benefit of employment.
- State the accommodations you are requesting based on your condition and affected job functions.
- Include any additional comments.
- Sign and date the form.
Part II: Deciding Official Documentation
- Enter the name of the applicant/employee.
- Provide the date of the oral request if different from the written request.
- Fill in the Deciding Official's name, title, SEID, phone number, and email address.
- Describe the duties or functions of the job that are limited by the applicant/employee's medical condition.
- Indicate if this limitation affects an essential function of the job or participation in the application process, and explain.
- State whether the requested accommodation will allow the applicant/employee to successfully perform essential job functions or participate in the application process.
- List any alternative accommodation recommendations.
- Determine if management needs medical documentation to make a decision on the request and explain if yes.
- Sign and date the form.
Part III-A: Medical Documentation
- Enter the name of the applicant/employee.
- Provide a diagnosis related to the reasonable accommodation request.
- Explain the impact of the medical condition on major life activities and any workplace safety concerns.
- Indicate the anticipated duration of the medical condition.
- Provide your name, telephone number, and best method and time to contact you.
- Sign and date the form.
Part IV: Denial of Reasonable Accommodation Request
- Complete this section only if the request is denied.
- Document the reasons for the denial.
- Sign and date the form.

After completing the form, make sure to return it to the designated fax number or the assigned Reasonable Accommodation Coordinator. If additional information is needed, consider attaching a separate sheet to ensure all details are adequately provided.

Important Facts about 13661

What is Form 13661 used for?

Form 13661 is a document used to request reasonable accommodations for employees or applicants with disabilities. It helps to formally document the request and the necessary medical information related to the disability. The form is divided into several parts, each serving a specific purpose in the accommodation process.

Who is required to complete Form 13661?

The form must be completed by the applicant for employment, the employee requesting the accommodation, or an IRS official involved in the process. Medical professionals such as health care practitioners, social workers, or rehabilitation counselors may also need to fill out specific sections related to medical documentation.

What information must be provided in Part I of the form?

In Part I, the applicant or employee must provide personal information, including their name, job title, and contact details. They must also describe their medical condition, how it limits their job functions, and the specific accommodations they are requesting to perform their duties effectively.

What is the role of the Deciding Official in this process?

The Deciding Official is responsible for reviewing the accommodation request. They complete Part II of the form, which includes assessing how the medical condition affects the employee's job functions and whether the requested accommodations are appropriate. This official must also document their decision regarding the request.

Is medical documentation necessary for the request?

Yes, medical documentation is often required, especially if the disability is not obvious. This documentation should confirm the existence of the disability and the need for the requested accommodations. It is critical for supporting the request and ensuring compliance with legal requirements.

What happens if the accommodation request is denied?

If the request for reasonable accommodation is denied, the Deciding Official must complete Part IV of the form to document the reasons for the denial. This section provides clarity on the decision and may include alternative recommendations for accommodations if applicable.

What should be done if additional space is needed on the form?

If there is insufficient space on any part of the form to provide the necessary information, applicants or officials are encouraged to attach additional sheets. This ensures that all relevant details are included and that the accommodation request is thoroughly documented.

Common mistakes

Filling out Form 13661 can be a straightforward process, but many individuals make common mistakes that can hinder their reasonable accommodation requests. One frequent error is incomplete information. Applicants often leave out critical details such as their medical condition or how it affects their job functions. This lack of information can lead to delays or denials in processing the request.

Another mistake is failing to provide adequate medical documentation. Parts III-A and III-B require input from a healthcare professional, yet some applicants neglect to include this essential paperwork. Without proper documentation, the decision-making process may be compromised, resulting in a potential denial of the accommodation.

Many people also forget to specify the accommodations they are requesting. Simply stating a medical condition without explaining what adjustments are needed does not provide enough context for decision-makers. Clear and specific requests help the Deciding Official understand how to best support the applicant.

Inaccurate contact information is another common pitfall. Applicants should ensure that all contact details, including phone numbers and email addresses, are correct. If the Deciding Official cannot reach the applicant, it could slow down the entire process.

Some individuals overlook the importance of signing and dating the form. An unsigned form may be considered incomplete, which can lead to unnecessary delays. A simple signature affirms that the information provided is true and complete to the best of the applicant's knowledge.

Additionally, applicants sometimes fail to attach supplementary information when there is not enough space on the form. If more details are necessary, providing them as an attachment is crucial. This ensures that all relevant information is available for review.

Lastly, a significant mistake is not following the submission instructions. Applicants should carefully read the guidelines on how to return the form, including fax numbers or specific coordinators. Not adhering to these instructions can result in the form being misdirected or lost, further complicating the accommodation request process.

Documents used along the form

The 13661 form is essential for individuals seeking reasonable accommodations in the workplace. Several other forms and documents are often used in conjunction with the 13661 form to ensure a comprehensive and effective accommodation process. Below is a list of these related documents, along with brief descriptions of each.

Form 12986 – Nondisclosure of GINA Protected Information: This document informs individuals about the Genetic Information Nondiscrimination Act (GINA) and its restrictions on requesting genetic information from employees or their family members.
Family and Medical Leave Act (FMLA) Certification: This form is used to certify the need for leave due to a serious health condition, allowing employees to provide necessary medical information while complying with GINA.
Medical Documentation (Part III-A of Form 13661): Completed by a healthcare practitioner, this section provides details about the medical condition affecting the employee and its impact on major life activities.
Limitations Worksheet (Part III-B of Form 13661): This document is also filled out by healthcare practitioners and outlines specific limitations resulting from the employee's medical condition.
Deciding Official Documentation (Part II-A of Form 13661): This part is completed by the Deciding Official to document the evaluation of the reasonable accommodation request and any recommendations made.
Action by Deciding Official (Part II-B of Form 13661): This section records the final decision regarding the accommodation request, whether it is approved or denied, and includes any additional notes.
Supplemental Medical Records: Additional medical records may be required to support the reasonable accommodation request, providing further context or clarification on the employee's condition.
Job Description: A current job description is often included to clarify the essential functions of the position and how the employee's medical condition affects their ability to perform these tasks.
Accommodation Request Letter: This letter, written by the employee, outlines the specific accommodations being requested and justifies their necessity based on the medical condition.
Follow-up Communication Records: Documentation of any follow-up communications between the employee and management regarding the accommodation request, including emails or meeting notes, may be useful for tracking the process.

These forms and documents work together to facilitate the reasonable accommodation process, ensuring that all necessary information is collected and evaluated appropriately. Each document plays a crucial role in supporting the employee's request and ensuring compliance with relevant laws and regulations.

Similar forms

Form 12986 – Nondisclosure of GINA Protected Information: Similar to Form 13661, this document provides guidelines on protecting genetic information during the reasonable accommodation process. Both forms emphasize the importance of confidentiality and compliance with relevant laws.
Family and Medical Leave Act (FMLA) Certification: Like Form 13661, the FMLA certification requires medical documentation to support a leave request. Both documents aim to ensure that necessary accommodations or leaves are granted based on medical needs.
ADA Accommodation Request Form: This form is used to request accommodations under the Americans with Disabilities Act. It shares similarities with Form 13661 in that both require detailed information about the individual's medical condition and the specific accommodations needed.
Employee Medical Leave Request Form: This document serves to request medical leave, similar to how Form 13661 requests accommodations. Both forms require information about the employee's medical condition and its impact on work duties.
Job Accommodation Network (JAN) Request Form: This form helps individuals request workplace accommodations. It parallels Form 13661 in its focus on identifying specific needs and documenting the relationship between the condition and required accommodations.
Rehabilitation Act Documentation Form: This form is used to document requests for accommodations under the Rehabilitation Act. It is similar to Form 13661 in that both require medical documentation and a description of how the condition affects job performance.
Disability Verification Form: This document verifies an individual's disability status, much like the medical documentation required in Form 13661. Both forms aim to establish the need for accommodations based on the individual's health condition.

Dos and Don'ts

When filling out Form 13661, it is crucial to follow specific guidelines to ensure your request for reasonable accommodation is processed smoothly. Below is a list of things you should and shouldn't do.

Do provide complete and accurate information in all sections of the form.
Do attach any additional information if you run out of space in the designated sections.
Do clearly describe your medical condition and how it affects your job functions.
Do specify the accommodations you are requesting based on your needs.
Don't include any genetic information that is not required by law.
Don't leave any sections blank; incomplete forms may delay the process.
Don't hesitate to seek assistance if you are unsure about how to fill out the form.

Misconceptions

Understanding the 13661 form can be challenging due to various misconceptions. Below is a list of common misunderstandings and clarifications regarding this form.

Misconception 1: The 13661 form is only for employees with visible disabilities.

This form is applicable to all individuals who may require reasonable accommodations, regardless of whether their disabilities are visible or not.

Misconception 2: Completing the form guarantees approval for accommodations.

While submitting the form is necessary, approval is contingent upon the review process and the specific circumstances of each request.

Misconception 3: Medical documentation is not required for all requests.

Medical documentation is essential when the disability or need for accommodation is not obvious. It helps substantiate the request.

Misconception 4: The information provided on the form will not be kept confidential.

The form includes a Privacy Act Statement, ensuring that the information is handled with confidentiality and used solely for the purpose of processing the accommodation request.

Misconception 5: Only the employee can submit the form.

While the employee typically fills out the form, a representative can assist or submit it on their behalf if necessary.

Misconception 6: There is no need to provide additional information if the form is incomplete.

If there is insufficient space on the form, individuals are encouraged to attach additional information to ensure their request is fully documented.

Misconception 7: The Deciding Official has unlimited authority to approve or deny requests.

The Deciding Official must follow guidelines and consider the specific circumstances of each case when making a decision.

Misconception 8: The form is only relevant for current employees.

The 13661 form can also be used by applicants seeking employment who may need accommodations during the application process.

Key takeaways

Filling out and using the 13661 form is an important step in requesting reasonable accommodations. Here are some key takeaways to keep in mind:

Understand the Purpose: The form is designed to document requests for reasonable accommodations due to medical conditions. It is essential for both employees and employers.
Complete All Relevant Parts: Ensure that you fill out all sections of the form accurately. Each part serves a specific purpose, from documenting the request to providing medical information.
Provide Medical Documentation: If required, include medical documentation from a qualified health care professional. This documentation should clearly outline the medical condition and its impact on job performance.
Be Clear About Your Needs: Clearly describe the accommodations you are requesting. Specify how these adjustments will help you perform your job effectively.
Attach Additional Information if Necessary: If you run out of space on the form, feel free to attach additional information. This can help ensure your request is fully understood.
Know Your Rights: Familiarize yourself with your rights under the Americans with Disabilities Act and the Rehabilitation Act. Understanding these laws can empower you during the accommodation process.

By keeping these points in mind, you can navigate the reasonable accommodation request process more effectively.