Ada accommodation request form pdf 2025

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The document is a certification form from the Housing Authority of the City of Los Angeles (HACLA) for requesting reasonable accommodations in subsidized housing due to a disability. It outlines the process for individuals to provide necessary information regarding their disability and how it relates to the requested accommodation, ensuring equal access to HACLA programs. The form requires signatures from both the requester and a healthcare provider, along with specific details about the disability and accommodation.

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How do I write a request for accommodations?

Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

What is an example of a letter of accommodation?

Dear [Supervisor John Smith], I am writing to request job accommodations for my diabetes under the Americans with Disabilities Act. Due to my disability, I require simple accommodations to perform my essential job functions. I have provided you with documentation of my disability and my need for job accommodations.

How do you write a letter requesting for accommodation?

Dear [Insert employers name here]: I am writing this letter to submit a request for accommodations in the workplace. I have pain in my lower back. Sitting or standing for long periods of time in the same position is causing increased pain and is decreasing my mobility.

Who can complete ADA paperwork?

This is not an exhaustive list under the ADA, appropriate professionals may also include certified physician assistants, nurse practitioners, social workers, and other professionals.

How to write a letter to accommodation?

I am experiencing the following difficulties in performing my job because of my disability: . I am writing to request that you (state requested accommodation) because it will (how it will help you do your job) as a reasonable accommodation.

hacla reasonable accommodation form

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Who can write an ADA accommodation letter?

This is a list of people who can provide verification letters ing to the California Fair Housing and Employment Act regulations, 2 CCR 12178(g): A medical professional. A health care provider, including the office of a medical practice. A peer support group.

What is an ADA accommodation request form?

An employer may use this form to document the determination of an employees request for a reasonable accommodation under the Americans with Disabilities Act (ADA). The form is intended for private employers.