GSA Form 3677 "Review of Reasonable Accommodation Request"-2025

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  1. Click ‘Get Form’ to open the GSA Form 3677 in our editor.
  2. Begin by entering the 'Name of Requestor' in the designated field. Ensure that this is clearly printed or typed for legibility.
  3. Next, specify the 'Type(s) of Accommodation Requested.' Be as detailed as possible to ensure clarity in your request.
  4. Fill in the 'Date of Request' to document when the accommodation was requested.
  5. In the 'Decision' section, check either 'Approved' or 'Denied,' and provide the corresponding date. If denied, specify reasons and any alternative accommodations offered.
  6. If reconsideration is desired, follow the outlined instructions for requesting a review of the decision. This may involve contacting higher management or filing an EEO complaint if necessary.
  7. Finally, ensure that both the decision maker's signature and name are included along with the date at the bottom of the form before submitting it.

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Examples of reasonable accommodations include providing interpreters, readers, or other personal assistance; modifying job duties; restructuring work sites; providing flexible work schedules or work sites (i.e. telework) and providing accessible technology or other workplace adaptive equipment.
You should respond to the request, engage in the interactive process, and implement the accommodation expeditiously. Unnecessary delays can result in a violation of the ADA.
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
Reasonable accommodation is any modification or adjustment to a job or the work environment that will enable an applicant or employee with a disability to participate in the application process or to perform essential job functions.
The individual with a disability requiring the accommodation must be otherwise qualified, and the disability must be known to the employer. In addition, an employer is not required to make an accommodation if it would impose an undue hardship on the operation of the employers business.
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To help determine effective accommodations, the Equal Employment Opportunity Commission (EEOC), recommends that employers use an interactive process, which simply means that employers and those individuals with disabilities who request accommodations work together to come up accommodation solutions.
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.
Whether or not an accommodation is reasonable will vary according to the position the employee holds, the way their disability affects their ability to do their job, and the environment that they work in.

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