WHO IS SEEKING A REASONABLE ACCOMMODATION
WHAT IS THE CALLER’S NAME? TELEPHONE NUMBER?
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WHAT IS THE CALLER’S RELATIONSHIP TO THE DEEOIC (e.g. Claimant, AR, DOE or NIOSH personnel, etc.)?
IF THE CALLER IS NOT THE EMPLOYEE, WHAT IS THE EMPLOYEE’S NAME? CASE ID #? LAST 4 DIGITS OF SSN? (This information is necessary to determine which DO has jurisdiction over the case and will be handling the request for reasonable accommodation).
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WHAT IS THE NATURE OF THE DISABILITY FOR WHICH S/HE IS SEEKING REASONABLE ACCOMMODATION?
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WHAT SPECIFIC ACCOMMODATION IS THE INDIVIDUAL SEEKING? BE AS SPECIFIC AS POSSIBLE
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ANY OTHER USEFUL INFORMATION
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