I have experienced an increase in fatigue, as well as eye irritation. It has become more difficult to breathe while in the office, even in my own personal office.
Given ongoing construction in our building and increased dust from it, my allergy symptoms have greatly increased. Would you please let me know in the next week? Thank you for considering my request.ĬC: to appropriate individuals Sample Accommodation Request Letter: Allergies Please let me know if you need additional information or would like to discuss additional ideas. If there are any other ideas or options that you could provide it would be greatly appreciated. Below I have included some possible ideas that could help at my workstation. I would like to request for accommodations to help decrease the pain caused by my back condition. Sitting or standing for long periods of time in the same position is causing increased pain and is decreasing my mobility. I am writing this letter to submit a request for accommodations in the workplace. Sample Accommodation Request Letter: Back Condition For accommodation ideas by disability or limitation, visit JAN’s A to Z page. As you consider these examples, you may find it helpful to review How to Disclose a Disability and Request Accommodations in the Workplace on JAN’s page for Individuals, which also provides more information about the Americans with Disabilities Act (ADA). But for employees who need more ideas, the following examples offer additional guidance about how to communicate the need for an accommodation for various types of medical conditions.
At JAN, I often discuss options with employees about what might be useful to include and how to clearly explain what accommodation is needed.Īs a starting point, JAN offers general guidance about writing an accommodation request letter, which lays out possible elements to include in the body of the letter.
However, writing such an initial request can feel intimidating and employees can get nervous about what to include in the letter and how to word it. I often suggest employees consider making a written request so they can decide what to say and how to say it without the stress of a face-to-face meeting with their employer. The first step in requesting an accommodation in the workplace is to decide how to make the request. A copy of the award or other document showing the details of the payment is attached.From the desk of Jose Gonzalez Lopez, MPH, Consultant - Sensory/Motor Teams I received an award or other payment to cover some or all of my attorney fees. A copy of the agreement or order is attached. I received a lump-sum settlement or court-ordered payment. I have attached proof that I have paid these expenses (see the OUT-OF-POCKET EXPENSE Instructions to determine what proof is necessary). I have attached copies of the necessary documents to prove my case (see the OUT-OF-POCKET EXPENSE Instructions to determine what proof is necessary). My retirement coverage has not been corrected to the _ retirement system.įor Social Security taxes (FICA) and CSRS retirement deductions paid, please provide the amount paid and the agency to which payment was made.įor reimbursement of interest paid on a CSRS (Offset) deposit, please demonstrate why your election of CSRS (Offset) does not fully compensate you for the error.įor all other expenses, please show (1) amount paid, (2) to whom paid, (3) why you believe the expense resulted from the coverage error, and (4) how that course of action would have corrected/mitigated the effect of the coverage error. My retirement coverage was corrected to the _ retirement system on (date) _. I was incorrectly placed in the _ retirement system on (date) _. The name and address of my current or last Federal employer is _ My name is _, my SS# is _,Īnd my address is _. Re: Request for Reimbursement of Out-of-Pocket Expenses
Benefits Officers Center Toggle submenuįederal Erroneous Retirement Coverage Corrections Act (FERCCA) Request for Reimbursement Sample Letter.