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The 13661 form is a document used to request reasonable accommodations in the workplace for individuals with disabilities. It serves as a structured way for applicants or employees to communicate their needs, allowing employers to assess and respond appropriately. Understanding the nuances of this form is essential for both employees seeking accommodations and employers responsible for facilitating these requests.

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Contents

The 13661 form plays a crucial role in the process of requesting reasonable accommodations for individuals with disabilities within the workplace. This form is divided into several parts, each designed to facilitate clear communication and documentation regarding the accommodation needs of applicants or employees. Part I requires the individual requesting accommodation to provide essential personal information, describe their medical condition, and outline how it affects their job functions. Following this, Part II is completed by a Deciding Official, who assesses the request and determines whether the proposed accommodation will enable the individual to perform their essential job functions. Medical documentation is addressed in Parts III-A and III-B, where healthcare professionals are tasked with providing evidence of the individual's condition and its impact on their daily life and work capabilities. In cases where a request for accommodation is denied, Part IV serves to formally document the reasons for the denial. Importantly, the form also includes a Privacy Act Statement, ensuring that the information provided is handled with care and confidentiality. This comprehensive structure aims to support individuals in navigating their rights while fostering an inclusive work environment.

Preview - 13661 Form

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Instructions for Form 13661, Reasonable Accommodation Request

This form is intended to assist persons involved in the reasonable accommodation process and to

memorialize important information. Completion of the form, including medical documentation if the

condition is not obvious or history of, is strongly encouraged for Agency Reasonable Accommodation

Services (RAS) review and record keeping purposes.

Part I – Written Reasonable Accommodation Request

To be completed by applicant for employment, employee, representative, or by an IRS

official when necessary to document a reasonable accommodation request. Submitting

any medical or other supporting documentation with Part I will help expedite the

processing of the request for accommodation.

Part II-A – Deciding Official Documentation

To be completed by Supervisor or Deciding Official addressing management's decision.

Management makes the final decision on a request for accommodation.

Part II-B –

Deciding Official Documentation

To be completed by Supervisor or Deciding Official addressing management's decision.

Management makes the final decision on a request for accommodation. A temporary

request, condition, or accommodation should be documented on Part I and Part II with re-

evaluation or ending date.

Part III-A – Medical Documentation

To be completed by Health Care Practitioner, Social Worker, or Rehabilitation Counselor.

Part III-B – Medical Documentation (Limitations Worksheet)

To be completed by Health Care Practitioner, Social Worker, or Rehabilitation Counselor.

Note: Medical documentation is generally not required where the disability is obvious or

known to the Agency and the nexus between the disability and the requested

accommodation is apparent.

Part IV – Denial of Reasonable Accommodation Request

To be completed by Deciding Official to document the denial of reasonable

accommodation.

Authorization of Representation – To be completed by representative and/or employee for

authorized representation for request.

Collection of the requested information is authorized by Section 501 of the Rehabilitation Act, 29 U.S.C. § 791.The information you

furnish will be used for the purpose of facilitating your request. Additionally, the information may be used to disclose information to:

appropriate Federal, state or local agencies when relevant to civil, criminal or regulatory investigations or prosecutions when necessary

to adjudicate a claim for benefits; a Federal agency in connection with a decision in hiring, retention or the granting of a security

clearance. It may also be used in an administrative or judicial proceeding affecting an employee's personnel rights and in any criminal

prosecutions for willfully making false or fraudulent statements in violation of U.S.C. § 1001. Additional uses may include disclosure to

the Department of Justice for the purpose of litigating any civil, administrative, or judicial proceeding where the United States, the IRS,

or its employees (in their official capacities or where the government has decided to represent them) are parties. It may also be used in

response to subpoena from a third party provided that (1) IRS is a party in interest, (2) the records are relevant and necessary to the

litigation, and (3) not otherwise privileged. This information may be provided to professional associations, such as state bar disciplinary

authorities, for use in connection with their administration of standards of conduct. Further, it may be disclosed to contractors when

necessary to perform work associated with reasonable accommodation and to those Federal agencies that oversee property and

procurement matters. Furnishing the requested information is required to establish that you have a covered disability, the functional

limitations of your disability, and the need for reasonable accommodation. Failure to fully complete the form or refusal to provide the

requested documentation may lead to a breakdown in the reasonable accommodation process and could result in a determination that

you are not entitled to reasonable accommodation.

Privacy Act Statement

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Nondisclosure of GINA Protected Information

The Genetic Information and Nondiscrimination Act of 2008 (GINA) prohibits employers and other

entities covered by GINA Title II from requesting, requiring, or purchasing genetic information of

employees or their family members, except as specifically allowed by this law. GINA has specific

exceptions for requests under the Family and Medical Leave Act and the Rehabilitation Act, as

explained below. To comply with GINA, we are asking that you not provide any genetic information

when responding to this request for medical information, unless the information is allowable as

explained below.

“Genetic information”, as defined by GINA, includes information concerning the manifestation of

disease/disorder in family members (“family medical history”), information about an individual's or

family member's genetic tests, the fact that an individual or an individual's family member sought or

received genetic services, and genetic information of a fetus carried by an individual or an individual's

family member or an embryo lawfully held by an individual or family member receiving assistive

reproductive services. Document 12986 - Nondisclosure of GINA Protected Information

(Provided for your information).

Family and Medical Leave Act (FMLA)

The general prohibition against requesting or requiring genetic information does not apply where

an employer requests medical information of an employee who invokes the FMLA to attend to

the employee's own serious health condition or where an employee complies with the employer's

return to work certification requirements. See 29 CFR 1635.8(b)(1)(i)(D)(2). An employer does not

violate GINA by asking an employee seeking FMLA leave to care for a seriously ill family member to

provide family medical history to comply with the certification provisions of the FMLA. See 29 CFR

1635.8(b)(3).

Further, GINA permits disclosure of relevant genetic information consistent with the requirements of

the FMLA to persons with a need to know the information because of responsibilities relating to the

handling of FMLA requests. See 29 CFR 1635.9(b)(5).

Rehabilitation Act

The general prohibition against requesting or requiring genetic information does not apply where an

employer requests documentation to support a request for reasonable accommodation as long as the

request for documentation is lawful. Such a request is lawful only where the disability and/or the need

for accommodation is not obvious; the documentation required contains no more information than

what is sufficient to establish that an individual has a disability and needs reasonable accommodation;

and the documentation relates only to the impairment that the individual claims to be a disability that

requires reasonable accommodation. See 29 CFR 1635.8(b)(1)(i)(D)(1); see also 29 CFR 1635.8(b)

(1)(i)(B).

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part I

Part I. Written Reasonable Accommodation Request

To be completed by applicant, employee, or IRS official

1. Applicant/Employee information

Last name First name

2. Occupational

SEID Series Grade

3. Operating Division/Function

4. Contact information

Office telephone number FAX number Tour of Duty/Shift (work hours)

Post of Duty (POD) City State ZIP code

E-mail address Preferred method/time to contact (cell phone or email, hours)

Cubicle, floor, or building code

5. Mailing address (where you receive official correspondence)

Address 1

(work)

Address 2

(home)

Room # Mail Stop City State ZIP code

6. Manager's contact information

Manager's name Telephone number E-mail address

ZIP codeStatePost of Duty (POD) City

SEID

7. Medical condition

(Describe your medical condition requiring accommodation.)

8. Job functions affected

(Describe how your medical condition limits your ability to perform your current duties, participate in the application process,

or access a benefit of employment. Copy of position description or clarify essential job functions impacted.)

9. Accommodation requested

(Based on your disability or medical condition and job functions affected, what accommodations would help you to

perform effectively.)

10. List alternative accommodation options to consider

I affirm that all statements made above are true to the best of my knowledge and belief.

Signature of Applicant/Employee Date signed

Authorization of Representation Name / Contact Information (attach release form to package)

eFAX 855-679-8653 or * RA Form 13661

Page

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part II-A

Part II-A. Supervisor/Deciding Official Documentation

To be completed by Supervisor/Deciding Official

1. Name of Applicant/Employee RA case number

2. Supervisor/Deciding Official

Last name First name Title SEID

ZIP codeStatePost of Duty

(POD)

City

Telephone number

(Including Area Code)

E-mail address

3. Is the employee's/applicant's condition obvious or otherwise known to management

Yes No

4. What duties or functions of the job are limited by the applicant/employee's medical condition.

(Refer to the Position Description, Critical

Job Elements (CJE), applicant requirements, or other relevant documentation).

5. Does this limitation affect an essential function of the job or participation in the application process

(See RAC if

essential job function worksheet is needed).

Explain answer

Yes No

6. Will the requested accommodation allow the applicant/employee to successfully perform the

essential job functions or participate in the application process. Explain answer

Yes No Not sure

7. Describe any interim accommodation efforts, alternative accommodation recommendations or previously approved accommodations

8. Further medical information/review: Does management need additional medical information

Yes No

9. Potential review through Federal Occupational Health (FOH)

Yes No

If either additional medical information or review by FOH is necessary. Explain the need

(Additional medical information should not

be sought where the condition is obvious or known and the connection to the requested accommodation is apparent)

I affirm all statements made above are true to the best of my knowledge and belief.

Signature of Supervisor/Deciding Official Date signed

eFAX 855-679-8653 or * RA Form 13661

Reasonable Accommodation Request

Department of the Treasury - Internal Revenue Servicepublish.no.irs.govCatalog Number 39619X

Form

13661

(Rev. 10-2020)

Part II-B

Part II-B. Action by Deciding Official

To Be Completed After Review of Accommodation Request

Request approved Alternative accommodation approved Accommodation denied

If an alternative accommodation approved, describe accommodation approved

If the condition and/or accommodation is temporary, document specifics with date to re-evaluate. Review date

Signature of Deciding Official Date signed

Deciding Official

Last name

First name Title SEID

Telephone number

(Including Area Code)

E-mail address

Post of Duty

(POD)

City State ZIP code

eFAX 855-679-8653 or * RA Form 13661

Reasonable Accommodation Request

Department of the Treasury - Internal Revenue Servicepublish.no.irs.govCatalog Number 39619X

Form

13661

(Rev. 10-2020)

Part III-A Name of Health Care Practitioner, Social Worker, Rehabilitation Counselor Best method and time to contact Signature

Part III-A. Medical Documentation

To be completed by a Health Care Practitioner, Social Worker, or Rehabilitation Counselor

Name of Applicant/Employee

Instructions

We have been requested to consider a reasonable accommodation for the individual named above. An accommodation is a

modification made to a job and/or the work environment that enables a qualified employee/applicant with a disability to successfully

perform the essential duties or functions of the position. We request that you provide medical information which reflects:

• the individual has one or more physical or mental impairment that substantially limit(s) one or more of his/her major life activities

(e.g., walking, speaking, breathing, hearing, seeing, thinking, sitting, standing, reaching, interacting with others, learning,

performing manual tasks, caring for oneself, concentrating, lifting, working, sleeping),

• a relationship or nexus between the medical condition(s) and the recommended accommodation(s).

Medical Documentation; provide a copy of employee position or job description

1. Have you made a diagnosis that relates to this reasonable accommodation request? State the diagnosis

2. Describe what limitations result from this condition, address any workplace safety concerns or impact to perform essential job duties

that may result from the condition.

(Complete Part III-B)

3. What is the anticipated duration of this medical condition

4. Recommended options or alternatives for accommodation efforts

Certification

Name of Health Care Practitioner, Social Worker, Rehabilitation Counselor Telephone number Best method and time to contact

I understand an IRS medical consultant may contact me for additional information.

Signature Date signed

eFAX 855-679-8653 or

* RA Form 13661

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part III-B

Part III-B. Medical Documentation

To be completed by a Health Care Practitioner, Social Worker, or Rehabilitation Counselor

Name of Applicant/Employee

Instructions

1. The following table indicates the major life activity that is affected by the applicant/employee's medical condition. Major life

activities are those basic activities that the average person in the general population can perform with little or no difficulty.

2. Indicate only the major activity affected by the applicant / employee's medical condition by circling or checking the appropriate

block. Indicate the specific limitation of the applicant / employee resulting from their condition. Quantify their limitation in order for

the agency to determine appropriate workplace accommodations (1-2 hours, 100 feet, 75% of day, or other notation).

Activity Extent of Limitation Detailed Explanation/Recommendation

Sensory

Seeing/Vision

Hearing

Limited to:

Breathing/Respiratory

Limited to:

Speaking

Limited to:

Basic Mobility

Walking

Climbing stairs

Sitting

Standing

Limited to:

Hours per day

Distance

% of day

Secondary Mobility

Squatting/kneeling

Twisting (neck/waist)

Bending/stooping

Reaching above shoulder

Limited to:

Hours per day

Physical Exertion

Pushing/pulling

Lifting/Carrying

Limited to:

Number of pounds

Fine Motor Skills

Keyboard use

Repetitive use of hands

Grasping

Fine finger motions

Limited to:

Hours per day

Cognitive

Thinking

Learning

Comprehending

Concentrating

Limited to:

Caring for self

Self-medication/checks

Dressing

Limited to:

Mental/emotional

Limited to:

Sleeping

Limited to:

Other/Bodily Functions

Limited to:

Certification

Name of Health Care Practitioner, Social Worker, Rehabilitation Counselor Signature Date signed

eFAX 855-679-8653 or

* RA Form 13661

Reasonable Accommodation Request

Form

13661

(Rev. 10-2020)

Catalog Number 39619X publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Part IV

Part IV. Denial of Reasonable Accommodation Request

To be completed by Deciding Official

Name of Applicant/Employee RA case number

Accommodation requested Accommodation offered to Applicant/Employee

1. Reason for denial

(check all that apply)

Accommodation Ineffective/Inappropriate

Accommodation Would Cause Undue Hardship

Employee did not accept an alternative accommodation offered

Medical Documentation Inadequate

Accommodation Would Require Removal of Essential Function

Accommodation Would Require Lowering of Performance or Production Standard

Other (Identify)

2. Detailed reason(s) for the denial of reasonable accommodation

(e.g., why accommodation is ineffective or causes undue hardship)

3. If the individual did not accept an alternative accommodation, explain how the alternative accommodation addresses the limitation,

and why you believe the chosen accommodation would be effective

4. Appeal Process:

• Refer to IRM 1.20.2.

• A request to the Deciding Official for reconsideration based on new medical documentation or other previously unavailable

information may be made within 15 business days of receipt of this denial.

• An appeal to the Business Unit Chief/Commissioner may be initiated within 15 business days of the denial of accommodation or

within 15 business days of a denial of a request for reconsideration by the Deciding Official, unless an alternative effective

accommodation has been offered.

• To initiate an EEO complaint contact an EEO counselor within the IRS within 45 calendar days of an allegedly discriminatory

action/event.

• Bargaining Unit employees may file a grievance in accordance with the terms of the collective bargaining agreement.

• An appeal to the Merit Systems Protection Board may be filed within 30 calendar days of an adverse action as defined in 5 C.F.R.

1201.3.

Signature of Deciding Official

(If denied)

Date signed

eFAX 855-679-8653 or * RA Form 13661

▼ PDF

Document Specifics

Fact Name	Fact Details
Form Purpose	The 13661 form is designed for individuals to request reasonable accommodations in the workplace due to medical conditions.
Parts of the Form	The form is divided into four main parts: the accommodation request, documentation by the deciding official, medical documentation, and denial of request.
Completing the Form	Applicants, employees, or IRS officials must complete Part I to document their accommodation request.
Medical Documentation	Parts III-A and III-B require completion by a healthcare practitioner, social worker, or rehabilitation counselor to provide medical insights.
Privacy Act Statement	The form includes a Privacy Act Statement, ensuring that the collected information is used solely for processing the accommodation request.
GINA Compliance	The form adheres to the Genetic Information Nondiscrimination Act (GINA), prohibiting the collection of genetic information unless specifically allowed.
Rehabilitation Act Reference	It is governed by Section 501 of the Rehabilitation Act, which requires reasonable accommodation for individuals with disabilities.
Denial Process	If a request is denied, the Deciding Official must complete Part IV to document the reasons for the denial.
Additional Information	Attachments may be submitted if there is insufficient space on the form to provide necessary information regarding the accommodation request.

13661: Usage Instruction

Completing Form 13661 is a critical step in requesting a reasonable accommodation. This form helps document your needs related to your medical condition and how it affects your work. Once filled out, you will submit the form to the appropriate personnel for review. Here’s how to fill it out step-by-step.

Gather Your Information: Before you start, collect all necessary personal information, including your medical condition details and contact information.
Complete Part I: Fill out your name, job title, contact details, and describe your medical condition, how it affects your job functions, and the accommodations you are requesting.
Provide Manager’s Information: Include your manager's name and contact details in Part I to facilitate communication.
Sign and Date: At the end of Part I, sign and date the form to affirm that the information is accurate.
Submit Part I: Send Part I to the designated fax number or your assigned Reasonable Accommodation Coordinator.
Deciding Official Completes Part II: The Deciding Official will fill out their section, which includes evaluating your request and determining if additional medical documentation is needed.
Medical Documentation (Part III-A): A health care practitioner must complete this section, providing relevant medical information that supports your accommodation request.
Limitations Worksheet (Part III-B): If necessary, this section should also be filled out by the health care practitioner to detail specific limitations caused by your medical condition.
Part IV (if applicable): If your request is denied, the Deciding Official will complete this section to document the reasons for denial.
Keep Copies: Make sure to keep copies of all submitted forms for your records.

After submitting the form, you will await a response from the Deciding Official. They will review your request and the accompanying documentation before making a decision. This process ensures that your needs are considered appropriately and fairly.

Learn More on 13661

What is Form 13661 used for?

Form 13661 is designed to facilitate the process of requesting reasonable accommodations for individuals with disabilities in the workplace. It allows applicants, employees, or IRS officials to document their requests for accommodations that will enable them to perform essential job functions or participate in the application process effectively. The form includes sections for detailing personal information, medical conditions, job functions affected, and specific accommodations requested.

Who needs to complete Form 13661?

Form 13661 should be completed by individuals who are seeking reasonable accommodations due to a medical condition that limits their ability to perform their job. This includes current employees, applicants for employment, and IRS officials involved in the accommodation process. Additionally, healthcare practitioners, social workers, or rehabilitation counselors may need to complete parts of the form to provide medical documentation supporting the accommodation request.

What happens if I do not provide enough information on the form?

If you do not provide sufficient information on Form 13661, it may hinder the reasonable accommodation process. Incomplete forms can lead to delays or even a denial of your request. If there is not enough space on the form for your responses, you are encouraged to attach additional documentation. Providing clear and comprehensive information is crucial for ensuring that your needs are understood and met.

How is my personal information protected when I submit Form 13661?

Your personal information is protected under the Privacy Act. The information collected on Form 13661 is used solely for the purpose of processing your reasonable accommodation request. It may be shared with relevant federal, state, or local agencies only when necessary for investigations or legal proceedings. However, the IRS takes your privacy seriously and will only disclose information as required by law or for legitimate business purposes.

What should I do if my reasonable accommodation request is denied?

If your request for reasonable accommodation is denied, the Deciding Official will complete a section of Form 13661 to document the denial. You have the right to understand the reasons for the denial, and it is advisable to seek clarification on the decision. Depending on the circumstances, you may also want to consider appealing the decision or discussing alternative accommodations that may be more acceptable. Engaging in a dialogue with your employer can often lead to a satisfactory resolution.

Common mistakes

Filling out Form 13661 can be a straightforward process, but many people make common mistakes that can lead to delays or complications. Understanding these pitfalls can help ensure your reasonable accommodation request is processed smoothly.

One frequent mistake is failing to provide complete personal information. Applicants often skip sections such as their full name, contact information, or mailing address. This can hinder communication and lead to unnecessary delays. Always double-check that all requested information is filled out accurately.

Another common error involves vague descriptions of the medical condition. When detailing the condition requiring accommodation, be specific. Instead of simply stating "I have a disability," explain how it affects your daily work functions. Clear and detailed descriptions help the deciding official understand your needs better.

Many applicants also neglect to describe how their medical condition limits their ability to perform job functions. This section is crucial. It’s not enough to just mention the medical condition; you must articulate how it impacts your work. Providing concrete examples can strengthen your request.

Additionally, some individuals forget to specify the accommodations they are requesting. Simply stating that you need help is insufficient. Be proactive and suggest specific accommodations that would help you perform your job effectively. This shows that you have thought about your needs and are engaged in the process.

Another mistake is failing to sign and date the form. Without a signature, the request may be considered incomplete. Always ensure that you affirm the truthfulness of your statements by signing and dating the form before submission.

Lastly, some people overlook the importance of submitting any required medical documentation. If the form requests medical information, be sure to include it. This documentation is essential for validating your request and demonstrating the need for accommodation.

By avoiding these common mistakes, you can improve the chances of your reasonable accommodation request being approved. Take your time, provide thorough information, and ensure that all sections of the form are completed accurately.

Documents used along the form

The 13661 form is used for requesting reasonable accommodations in the workplace. Several other documents often accompany this form to provide necessary information and support the accommodation process. Below is a list of these documents along with brief descriptions of each.

Document 12986 – Nondisclosure of GINA Protected Information: This document informs individuals about the Genetic Information Nondiscrimination Act (GINA) and outlines the restrictions on providing genetic information during the accommodation request process.
Part II – Deciding Official Documentation: This section is completed by the Deciding Official to track the decision-making process regarding the reasonable accommodation request. It includes details about the employee's limitations and the requested accommodations.
Part III-A – Medical Documentation: Health Care Practitioners, Social Workers, or Rehabilitation Counselors complete this part. It provides medical information necessary to evaluate the accommodation request, including diagnoses and the impact on major life activities.
Part III-B – Medical Documentation (Limitations Worksheet): This worksheet is also completed by medical professionals to detail the limitations caused by the medical condition and to support the accommodation request.
Part IV – Denial of Reasonable Accommodation Request: This section is filled out by the Deciding Official if the accommodation request is denied. It documents the reasons for the denial.
Privacy Act Statement: This statement explains how the information collected will be used and the legal authority under which it is gathered. It emphasizes the confidentiality of the information provided.
Family and Medical Leave Act (FMLA) Documentation: This document may be required if the accommodation request involves time off for medical reasons. It outlines the employee's rights under FMLA and the necessary medical certifications.
Job Description: A current job description may be attached to clarify the essential functions of the employee's role. This information helps assess how the medical condition affects job performance.
Additional Attachments: If there is not enough space on the form for necessary information, additional attachments can be submitted. These may include further explanations or supporting documents relevant to the accommodation request.

These documents work together to ensure that the reasonable accommodation process is thorough and compliant with applicable laws. Proper completion and submission of these forms are essential for a successful accommodation request.

Similar forms

The Form 13661 is similar to the Family and Medical Leave Act (FMLA) documentation in that both processes require employees to provide specific medical information to support their requests. Under the FMLA, employees can take leave for serious health conditions affecting themselves or their family members. Like the 13661 form, FMLA documentation necessitates medical certification that outlines the nature of the condition and how it impacts the employee's ability to work. Both forms aim to ensure that employees receive the necessary support while also protecting the employer's right to verify claims.

Another document that shares similarities with the 13661 form is the Americans with Disabilities Act (ADA) request form. The ADA requires employers to provide reasonable accommodations for employees with disabilities. Just as the 13661 form captures the details of the accommodation request, the ADA request form also requires information about the employee's medical condition and the specific accommodations needed. Both forms emphasize the importance of clear communication between the employee and employer to facilitate a smooth accommodation process.

The Occupational Safety and Health Administration (OSHA) incident report form is another comparable document. While primarily focused on workplace safety, OSHA forms require detailed accounts of incidents that could affect an employee's ability to perform their job. Like the 13661 form, these reports gather essential information to assess the situation and determine necessary actions. Both documents serve to protect employees by ensuring that their health and safety concerns are formally recognized and addressed.

Similarly, the Equal Employment Opportunity Commission (EEOC) complaint form parallels the 13661 form in that it documents claims of discrimination, including those based on disability. The EEOC form collects information about the alleged discriminatory actions and the impact on the employee. Just as the 13661 form aims to establish a clear understanding of an employee's need for accommodation, the EEOC form seeks to clarify the circumstances surrounding a claim, ensuring that all parties involved have a comprehensive view of the situation.

The Social Security Administration (SSA) disability application is another document that shares a common purpose with the 13661 form. Both require individuals to provide medical evidence to support their claims of disability. The SSA application asks for detailed information about the applicant's medical condition, much like the medical documentation section of the 13661 form. Both processes aim to verify the existence of a disability and assess the need for benefits or accommodations.

Another similar document is the Veterans Affairs (VA) disability claim form. This form, like the 13661, requires veterans to provide medical documentation to support their claims for disability benefits. Both forms focus on establishing the extent of the disability and the impact it has on the individual’s daily life and work capabilities. They are essential for ensuring that individuals receive the benefits and accommodations they are entitled to based on their disabilities.

The Employee Assistance Program (EAP) referral form also bears similarities to the 13661 form. EAPs often assist employees dealing with personal or work-related issues, including mental health challenges. Both forms require employees to disclose relevant information about their situations to receive appropriate support. The emphasis on confidentiality and the need for accurate information is a common thread that connects these documents.

Additionally, the Workers’ Compensation claim form is comparable to the 13661 form in that it requires detailed information about an employee’s medical condition resulting from a work-related injury or illness. Both forms necessitate medical documentation to substantiate claims and determine eligibility for benefits or accommodations. They serve to protect the rights of employees while ensuring that employers can manage claims effectively.

Lastly, the Disability Insurance application form is similar to the 13661 form in that it requires individuals to provide evidence of their medical conditions to qualify for benefits. Just as the 13661 form aims to facilitate reasonable accommodations in the workplace, the Disability Insurance application seeks to ensure that individuals receive financial support during their time of need. Both forms emphasize the importance of providing accurate and comprehensive information to support claims.

Dos and Don'ts

When filling out Form 13661, it is essential to follow specific guidelines to ensure your request for reasonable accommodation is processed smoothly. Here are nine things you should and shouldn't do:

Do provide accurate and complete information in all sections of the form.
Do clearly describe your medical condition and how it affects your job functions.
Do include your contact information and that of your manager to facilitate communication.
Do submit additional documentation if you run out of space on the form.
Do affirm the truthfulness of your statements by signing the form.
Don't include any genetic information that is not relevant to your accommodation request.
Don't leave any sections blank unless they are not applicable to your situation.
Don't assume that verbal requests will be sufficient; always document your request in writing.
Don't hesitate to ask for help if you are unsure about how to fill out any part of the form.

Following these guidelines will help ensure that your request is considered appropriately and promptly. Proper documentation is crucial in the reasonable accommodation process.

Misconceptions

Misconception 1: The 13661 form is only for employees with permanent disabilities.

This form can be used by any applicant or employee who requires a reasonable accommodation, regardless of whether their condition is permanent or temporary.

Misconception 2: Completing the 13661 form guarantees that an accommodation will be granted.

Submitting the form does not ensure approval. Each request is assessed based on the specific circumstances and needs of the individual.

Misconception 3: Medical documentation is not necessary for all requests.

Medical documentation is required when the disability and need for accommodation are not obvious. This helps substantiate the request.

Misconception 4: The information provided on the form is not confidential.

Information submitted is protected under privacy laws. It is used solely for the purpose of evaluating the accommodation request.

Misconception 5: You can submit genetic information when completing the form.

According to the Genetic Information Nondiscrimination Act (GINA), genetic information should not be included unless specifically permitted.

Misconception 6: The 13661 form is only for employees of the IRS.

While the form is used within the IRS, it is applicable to any federal agency that follows similar reasonable accommodation procedures.

Misconception 7: The form must be filled out in its entirety without any attachments.

If there is insufficient space on the form, additional information can be provided as an attachment. This is encouraged for clarity.

Misconception 8: There is no time limit for submitting the 13661 form.

Timeliness is important. Delays in submission may affect the ability to provide accommodations in a timely manner.

Misconception 9: Only managers can initiate the accommodation request process.

Any applicant or employee can initiate a request. Managers play a role in the decision-making process but are not the only ones who can start it.

Misconception 10: Once a request is denied, it cannot be appealed.

Denials can be challenged. Individuals have the right to seek clarification or appeal the decision based on additional information or context.

Key takeaways

Here are some key takeaways about filling out and using the 13661 form:

Part I is essential: This section must be completed by the applicant, employee, or IRS official to document the reasonable accommodation request.
Medical documentation is required: Parts III-A and III-B must be filled out by a qualified health care practitioner, social worker, or rehabilitation counselor to support the accommodation request.
Additional information can be attached: If there is not enough space in any section, it is encouraged to provide additional details as an attachment.
Privacy is important: The information collected is protected under the Privacy Act and will only be used for the purpose of facilitating the accommodation request.