Administrative accommodations request form 2025

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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.
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.
Sufficient medical documentation should describe the nature, severity, and duration of the impairment, the activity or activities that the impairment limits, the extent to which the impairment limits the employees ability to perform the activity or activities, and should also substantiate why the requested reasonable
Respected Sir/Madam, I wrote this letter to you to request for accommodation for the month (Explain your requirement). I am (Job designation, e.g., security office ay night shift), having no relatives whatsoever in (Area name), and staying in the hostel far away. (Describe in your own words).
This is not an exhaustive list under the ADA, appropriate professionals may also include certified physician assistants, nurse practitioners, social workers, and other professionals.
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