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

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.

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