How to Fill Out and Submit an ADA Reasonable Accommodation Request Form

An ADA reasonable accommodation request form is any written document that tells your employer you need a change at work because of a medical condition, and the law does not require a specific format to make it valid.¹ You can use your employer’s internal form if one exists, a free sample from the EEOC or the Job Accommodation Network, or a letter you write yourself. What matters is the substance and that you keep a dated copy.

What Belongs in the Request

You don’t need to say “reasonable accommodation” or cite the ADA by name. All the law requires is that you let your employer know you need a change at work because of a medical condition. Since you’re writing it down, be specific. A strong request covers four things.

Who you are. Your name, job title, department, and supervisor. This is routing information so the request reaches the right person.

The barrier. Describe the specific job tasks or workplace conditions your disability makes difficult. Focus on functions, not your diagnosis. “I cannot sit for more than 30 minutes without severe pain” is more useful to your employer than the name of your spinal condition.

The accommodation you want. Be concrete. Instead of “I need help with my workstation,” ask for a height-adjustable desk, a screen reader, a modified start time, or permission to work remotely two days a week. Common accommodations employers provide include making facilities accessible, restructuring job duties, modifying schedules, acquiring or modifying equipment, changing policies, providing readers or interpreters, and reassignment to a vacant position.¹ If you’re unsure what to ask for, the Job Accommodation Network at askjan.org maintains a searchable database of accommodation ideas organized by disability and job function.

A signal you’re open to alternatives. The EEOC expects both sides to participate in an interactive process. Showing flexibility from the start strengthens your position, because your employer isn’t required to give you the exact accommodation you asked for if a different one would also be effective.

Where to Get a Form or Template

Many employers have their own request form, typically available through HR, an employee handbook, or an internal portal. If yours doesn’t, two free resources exist.

The EEOC published a sample “Confirmation of Request for Reasonable Accommodation” as part of its guidance on implementing accommodation procedures. It collects the requester’s name, contact information, the specific accommodation requested, and the reason for the request.²

The Job Accommodation Network provides a sample accommodation request letter that identifies you as a person with a disability, states you are requesting accommodation under the ADA, describes the problematic job tasks, proposes accommodation ideas, and references attached medical documentation.³

Either template works. Your employer cannot ignore a request just because you didn’t use their preferred format.¹

Medical Documentation to Attach

When your disability and need for accommodation aren’t obvious, your employer can ask for reasonable documentation. The law limits what they can request. They can ask for enough information to confirm you have an ADA-qualifying disability and that it creates a need for the accommodation you’ve requested. They cannot demand your complete medical records or information unrelated to the functional limitation at issue.¹

A useful letter from your provider covers the nature, severity, and expected duration of your condition, describes the specific limitations it places on your work activities, and explains why the requested accommodation would help.⁴ The provider does not need to be a physician. Psychologists, physical therapists, occupational therapists, and licensed mental health professionals all qualify. Ask your provider to focus on functional capacity rather than clinical detail your employer doesn’t need.

Filling in the Form

Keep clinical language out and functional language in. Instead of copying medical terminology from your provider’s letter, describe outcomes in workplace terms. “I cannot lift more than ten pounds due to a shoulder impairment” is clearer to an HR coordinator than a paragraph about rotator cuff pathology. Connect a specific limitation to a specific job function, then to a specific solution.

Fill in every field on a standardized form, even if a question seems redundant. Blank fields invite requests for clarification that slow the process down. If the form asks whether the accommodation is temporary or permanent, answer based on your provider’s assessment of the condition’s expected duration. Attach the provider’s letter and any other supporting documentation as a single packet.

Before you finalize, date the document. A clear date establishes when the clock starts on your employer’s obligation to respond.

How to Submit It

Direct your completed request to whichever person or office your employer designates: usually an HR representative, a direct supervisor, or a named ADA coordinator. If you’re not sure who handles these requests, HR is a safe starting point. The ADA doesn’t require you to notify any particular person, so a request to any supervisor or manager counts.

Email is the most practical delivery method for most people because it automatically timestamps the transmission and creates a retrievable copy for both sides. If you want a harder paper trail, send the packet by certified mail with return receipt requested. The return receipt gives you proof of exactly when the organization received your request.

Keep a full copy of everything you send: the form or letter, the medical documentation, and any cover email. If your employer sends a written acknowledgment, save that too. These records become important if the process stalls or if you eventually need to file a complaint.

What Happens After You Submit

Federal regulations call for a “flexible, interactive process” once your employer receives the request, with both sides working together to find an effective accommodation.⁵ In practice, this usually means a meeting or phone call where your employer asks about your limitations, reviews the accommodation you proposed, and discusses whether it’s feasible or whether an alternative would work.

Your employer is not required to give you the exact accommodation you asked for. If multiple accommodations would be effective, the EEOC says your preference should receive “primary consideration,” but the employer has “ultimate discretion” to choose among effective options, including less expensive or less burdensome alternatives.¹ The key word is “effective.” An accommodation that technically exists but doesn’t actually let you do your job isn’t enough.

No federal regulation sets a specific deadline for the employer’s response. Speed depends on the complexity of the request. A simple equipment purchase might resolve in a week, while a job restructuring could take longer. What matters is that the employer moves forward without unnecessary delay. Document every conversation and email exchange during this phase.

Confidentiality and Retaliation

Any medical information your employer collects through this process must be kept in separate files, apart from your regular personnel records, and treated as a confidential medical record. Only supervisors and managers who need to know about restrictions or accommodations, first aid and safety personnel where relevant, and government officials investigating ADA compliance can see it.⁶ Your coworkers have no right to your medical details.

The ADA also makes it illegal for an employer to punish you for requesting an accommodation. The statute prohibits discrimination against anyone who has opposed an unlawful practice or participated in a related proceeding, and it prohibits coercing, intimidating, or threatening anyone for exercising ADA rights.⁷ Retaliation can look like a demotion, a sudden negative performance review, exclusion from projects, schedule changes designed to pressure you into quitting, or termination. If adverse action follows soon after your accommodation request, that timing itself is evidence. The dated copy of your request establishes the sequence.

If Your Request Is Denied

Ask for the denial in writing and for a specific explanation of why the employer believes the accommodation would cause undue hardship. Sometimes what looks like a denial is actually a counteroffer, with the employer proposing an alternative that could work. Engage with that possibility before escalating.

If the employer has genuinely refused to accommodate you or refused to participate in the interactive process at all, you can file a charge of discrimination with the EEOC. You do not need to exhaust your employer’s internal grievance procedure first. The filing deadline is 180 calendar days from the discriminatory act in most jurisdictions, extended to 300 days if a state or local agency enforces a similar anti-discrimination law, which covers the majority of states.⁸

You can file the charge online through the EEOC’s public portal, in person at a local EEOC office, or by mail. The EEOC will investigate and may attempt mediation. If it finds reasonable cause to believe discrimination occurred, it will try to reach a settlement; if that fails, the EEOC may file a lawsuit on your behalf or issue you a right-to-sue letter allowing you to file your own case in federal court.

1
U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the ADA
2
U.S. Equal Employment Opportunity Commission. Practical Advice for Drafting and Implementing Reasonable Accommodation Procedures Under Executive Order 13164
3
Job Accommodation Network. How to Request an Accommodation – Accommodation Form Letter
4
Job Accommodation Network. Requests For Medical Documentation and the ADA
5
Legal Information Institute. 29 CFR Appendix to Part 1630 – Interpretive Guidance on Title I of the Americans with Disabilities Act
6
Office of the Law Revision Counsel. 42 U.S. Code 12112 – Discrimination
7
Office of the Law Revision Counsel. 42 U.S. Code 12203 – Prohibition Against Retaliation and Coercion
8
U.S. Equal Employment Opportunity Commission. How to File a Charge of Employment Discrimination