Attachment B (Form Md Eeocr-002-2017) - Confirmation Of Request For Reasonable Accommodation

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United States Mint Directive
MD EEOCR-002-2017
March 30, 2017
ATTACHMENT B
UNITED STATES MINT
CONFIRMATION OF REQUEST FOR REASONABLE ACCOMMODATION
SECTION A: (To be completed by the Receiving Official for verbal requests.)
Employee/Applicant
Name________________________
Date
______________
Telephone
Number___________________
Location_______________________
Office/Organization__________________________________________
Occupational Series and Grade________________________________
Briefly describe the specific accommodation requested, if known. (Be as specific as
possible, e.g., adaptive equipment, reader, interpreter, schedule change.)
If the
requested accommodation is time sensitive, please explain.
Briefly describe the medical reason for the requested accommodation.
SECTION B: (To be completed by the Deciding Official.)
_____ Accommodation approved as specifically requested
_____ Accommodation approved but different from original request. Alternative
accommodation offered was ____ accepted ____ rejected.
Please describe the alternative accommodation provided.
Explain why the original
accommodation requested was not provided and why the alternative accommodation
would be effective.
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