ADA REASONABLE ACCOMMODATION REQUEST — EMPLOYMENT

Table of Contents

1. Request Letter
2. Medical Documentation Attachment
3. Interactive Process Follow-Up
4. Legal Framework
5. State-Specific Notes
6. Practitioner Checklist

I. FORMAL ACCOMMODATION REQUEST

Date: [__/__/____]

To:
[EMPLOYER NAME / HUMAN RESOURCES DEPARTMENT]
[COMPANY NAME]
[ADDRESS]
[CITY, STATE ZIP]

From:
[EMPLOYEE FULL NAME]
[EMPLOYEE ID / DEPARTMENT, if applicable]
[ADDRESS]
[CITY, STATE ZIP]

Re: Request for Reasonable Accommodation Under the Americans with Disabilities Act

Dear [HR REPRESENTATIVE NAME / SUPERVISOR NAME]:

I am writing to formally request a reasonable accommodation under Title I of the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12112, and any applicable state disability discrimination laws.

Identification of Disability

I have a [physical / mental] condition — specifically, [GENERAL DESCRIPTION OF DISABILITY OR MEDICAL CONDITION] — that substantially limits one or more major life activities, including [IDENTIFY AFFECTED MAJOR LIFE ACTIVITIES — e.g., walking, standing, concentrating, breathing, seeing, hearing, working].

Current Job Functions Affected

My condition affects my ability to perform the following essential job functions:

☐ [DESCRIBE SPECIFIC JOB FUNCTION 1]
☐ [DESCRIBE SPECIFIC JOB FUNCTION 2]
☐ [DESCRIBE SPECIFIC JOB FUNCTION 3]

Requested Accommodation(s)

I respectfully request the following accommodation(s) to enable me to perform the essential functions of my position:

☐ Modified work schedule: [DESCRIBE — e.g., flexible start/end times, compressed workweek]
☐ Telework / remote work arrangement: [DESCRIBE frequency and terms]
☐ Physical workspace modification: [DESCRIBE — e.g., ergonomic equipment, accessible workspace]
☐ Assistive technology or equipment: [DESCRIBE]
☐ Job restructuring / reassignment of marginal functions: [DESCRIBE]
☐ Leave of absence: [DESCRIBE duration and purpose]
☐ Modified break schedule: [DESCRIBE]
☐ Reassignment to a vacant position: [DESCRIBE]
☐ Modified training materials or methods: [DESCRIBE]
☐ Other: [DESCRIBE]

Willingness to Engage in Interactive Process

I am prepared to participate in the interactive process as required by 29 C.F.R. § 1630.2(o)(3) and to provide any additional medical documentation that may be reasonably necessary to evaluate this request.

I am available to meet at your earliest convenience to discuss this request. Please contact me at [PHONE NUMBER] or [EMAIL ADDRESS].

Thank you for your prompt attention to this matter.

Sincerely,

_______________________________
[EMPLOYEE NAME]

Date: [__/__/____]

Sent via: ☐ Hand delivery ☐ Certified mail, return receipt requested ☐ Email (with read receipt)

II. MEDICAL DOCUMENTATION

HEALTHCARE PROVIDER CERTIFICATION

Date: [__/__/____]

To: [EMPLOYER NAME]

From: [HEALTHCARE PROVIDER NAME], [CREDENTIALS — M.D., D.O., Ph.D., etc.]

Re: [EMPLOYEE NAME] — Medical Support for Accommodation Request

I am the treating [physician / psychologist / healthcare provider] for [EMPLOYEE NAME]. Based on my professional evaluation:

1. [EMPLOYEE NAME] has a [physical / mental] impairment that substantially limits the major life activity/activities of [________________________________].

2. This condition is expected to be: ☐ Permanent ☐ Temporary (estimated duration: [____])

3. The following workplace limitations exist: [DESCRIBE FUNCTIONAL LIMITATIONS WITHOUT DISCLOSING SPECIFIC DIAGNOSIS UNLESS EMPLOYEE CONSENTS]

4. The following accommodation(s) would enable the employee to perform essential job functions: [DESCRIBE RECOMMENDED ACCOMMODATIONS]

_______________________________
[HEALTHCARE PROVIDER SIGNATURE]
[LICENSE NUMBER]
[CONTACT INFORMATION]

III. INTERACTIVE PROCESS FOLLOW-UP

[Use this section to document the interactive process if the employer does not respond within a reasonable time — typically 5-10 business days.]

Date: [__/__/____]

Dear [HR REPRESENTATIVE / SUPERVISOR]:

I submitted a reasonable accommodation request on [DATE OF ORIGINAL REQUEST]. As of this date, I have not received a response / the interactive process has not been initiated.

Under the ADA and 29 C.F.R. § 1630.2(o)(3), the employer is obligated to engage in a timely, good-faith interactive process upon receiving an accommodation request. Unnecessary delay in responding to a request may constitute a failure to provide a reasonable accommodation. See EEOC Enforcement Guidance on Reasonable Accommodation, Question 10.

I respectfully request that the interactive process be initiated within [NUMBER] business days.

Sincerely,

_______________________________
[EMPLOYEE NAME]

IV. LEGAL FRAMEWORK

Essential Elements of an ADA Accommodation Claim

To establish a failure-to-accommodate claim under ADA Title I, the employee must show:

1. Qualified Individual with a Disability: The employee has a disability as defined by 42 U.S.C. § 12102 and can perform the essential functions of the position with or without reasonable accommodation.

2. Known Disability: The employer knew or should have known of the disability.

3. Failure to Accommodate: The employer failed to provide a reasonable accommodation or failed to engage in the interactive process.

4. No Undue Hardship: The requested accommodation would not impose an undue hardship on the employer's operations (42 U.S.C. § 12111(10)).

Key Definitions

• Reasonable Accommodation: Modifications or adjustments to the work environment or the manner in which the position is customarily performed that enable a qualified individual with a disability to perform the essential functions (29 C.F.R. § 1630.2(o)).

• Undue Hardship: Significant difficulty or expense in relation to the employer's size, resources, nature, and structure (42 U.S.C. § 12111(10)).

• Essential Functions: The fundamental duties of the position, not marginal functions (29 C.F.R. § 1630.2(n)).

STATE-SPECIFIC NOTES

California

• State Law: FEHA (Cal. Gov't Code § 12940(m)) — broader than ADA; applies to employers with 5+ employees
• Interactive Process: Mandatory; failure to engage is an independent violation (Cal. Gov't Code § 12940(n))
• No Damage Caps: FEHA has no caps on compensatory or punitive damages

Texas

• State Law: Texas Labor Code Ch. 21 — mirrors ADA; applies to employers with 15+ employees
• Damage Caps: Same as federal ADA caps under 42 U.S.C. § 1981a

Florida

• State Law: Florida Civil Rights Act (Fla. Stat. § 760.10) — applies to employers with 15+ employees
• Note: Florida courts generally follow federal ADA precedent

New York

• State Law: N.Y. Exec. Law § 296 (Human Rights Law) — broader than ADA; applies to employers with 4+ employees
• City Law: NYC Human Rights Law (N.Y.C. Admin. Code § 8-107) — one of the broadest disability laws in the country; cooperative dialogue process required

PRACTITIONER CHECKLIST

☐ Confirmed employer has 15+ employees (ADA threshold) or check state law threshold
☐ Documented disability and functional limitations
☐ Submitted written accommodation request (kept copy)
☐ Obtained healthcare provider certification if requested
☐ Documented all communications in the interactive process
☐ Noted employer response timeline (or failure to respond)
☐ Assessed whether requested accommodation is "reasonable" (no undue hardship)
☐ Identified essential vs. marginal job functions (review job description)
☐ Filed EEOC charge within 180 days (or 300 days in deferral states) if accommodation denied
☐ Evaluated state and local law claims (broader coverage, no damage caps in some states)
☐ Checked employment agreement for arbitration clauses
☐ Preserved all documentary evidence

SOURCES AND REFERENCES

• 42 U.S.C. § 12101 et seq. — Americans with Disabilities Act
• 42 U.S.C. § 12112 — Prohibition on disability discrimination in employment
• 29 C.F.R. Part 1630 — EEOC ADA regulations
• ADA Amendments Act of 2008, Pub. L. 110-325 — broadened definition of disability
• EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship (2002)
• US Airways, Inc. v. Barnett, 535 U.S. 391 (2002) — reasonable accommodation standard