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VA Form 0857e. REQUEST FOR MEDICAL DOCUMENTATION. EMPLOYEE NAME. DATE (MM/DD/YYYY) DUE TO RAC BY (MM/DD/YYYY) Dear Health Care Provider: I have requested an accommodation (describe the requested accommodation here) To perform the essential functions of my position.
VA Form 0857a, Written Confirmation of Request for Accommodation [PDF]
At present, we only need the following information: the nature, severity, and duration of the impairment; one or more of the activities the impairment limits (walking, reaching, breathing, etc.); VA FORM SEP 2013. 0857e. (c) the extent or degree to which the impairment limits an activity;
Please return this form and the requested information to me via encrypted email (utilizing VA's internal email system) or by mail and/or via fax. (Enter complete e-mail address, mailing address and/or fax number.)
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ce of guidance for Reasonable Accommodations. RESPONSIBLE OFFICE: Office of Diversity and Inclusion (06), Office of Human Resources and Administra. RELATED DIRECTIVE: VA Directive 5975, Diversity and Inclusion. RESCISSIONS: VA Handbook 5975.1, Processing Requests for Reasonable Accommodation by Employees and Applicants with Disabilities ...
The form VA0857e- Request for Medical Documentation, needs to be completed by your medial provider. The provider will need to be very specific about your limitations as it relates to your job duties.
WRITTEN CONFIRMATION OF REQUEST FOR ACCOMMODATION. An oral request from an employee is sufficient to begin the reasonable accommodation process. Completion of this form is voluntary. However, individuals who have requested an accommodation are asked to fill out this form for record-keeping purposes.
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VA Form 0857a. WRITTEN CONFIRMATION OF REQUEST FOR ACCOMMODATION. An oral request from an employee is sufficient to begin the Reasonable Accommodation (RA) or Personal Assistance Services (PAS) process. Completion of this form is voluntary.