ADA Reasonable Accommodation Request
Submitted pursuant to the Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et seq.) and the ADA Amendments Act of 2008
Date: [Request Date]
TO: [HR Contact Name], [HR Title]
[Company Name]
[Company Address]
FROM: [Employee Name], [Job Title], [Department] Department
Employee ID: [Employee ID]
Phone: [Employee Phone] | Email: [Employee Email]
1. PURPOSE OF THIS REQUEST
I, [Employee Name], currently employed as [Job Title] in the [Department] Department at [Company Name], am submitting this formal request for a reasonable accommodation pursuant to Title I of the Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et seq.), as amended by the ADA Amendments Act of 2008 (ADAAA), and applicable EEOC regulations at 29 CFR Part 1630. I understand that [Company Name] is required by law to engage in an interactive process to determine whether a reasonable accommodation can be provided that would enable me to perform the essential functions of my position.
2. DESCRIPTION OF DISABILITY AND FUNCTIONAL LIMITATIONS
I have a disability as defined under 42 U.S.C. §12102, which constitutes a physical or mental impairment that substantially limits one or more major life activities. Specifically:
Nature of Disability or Medical Condition: [Disability Description]
Major Life Activity Substantially Limited: [Major Life Activity]
Impact on Job Functions: [Job Function Limitation]
I understand that I am not required to disclose a specific medical diagnosis in this request. Any medical information I provide will be maintained in a confidential file separate from my general personnel record, as required by 29 CFR §1630.14(d).
3. REQUESTED ACCOMMODATION(S)
I am requesting the following reasonable accommodation(s) to enable me to perform the essential functions of my position:
[Accommodation Requested]
How the Accommodation Will Enable Performance of Essential Job Functions:
[Accommodation Effectiveness]
I understand that the accommodation requested must be reasonable and must not impose an undue hardship on [Company Name] as defined in 42 U.S.C. §12111(10). I am willing to discuss alternative accommodations that achieve the same result if the specific accommodation(s) requested above are not feasible.
4. PRIOR ACCOMMODATION HISTORY
I have previously requested accommodations from [Company Name]. The details of that prior request and its outcome are as follows:
[Prior Accommodation Details]
5. MEDICAL DOCUMENTATION
Medical Documentation Enclosed: [Medical Doc Provided]
Supporting Healthcare Provider: [Medical Provider]
Healthcare Provider Contact: [Medical Provider Contact]
Pursuant to EEOC guidance on disability-related inquiries, I am providing (or am prepared to provide upon request) documentation from my healthcare provider sufficient to verify the existence of my disability and its functional limitations. I request that any such documentation be maintained in strict confidence and used solely for the purpose of evaluating this accommodation request.
6. REQUESTED START DATE AND ADDITIONAL INFORMATION
I respectfully request that the accommodation be in place no later than [Preferred Start Date]. I understand that implementation may require a reasonable period to arrange and am willing to discuss interim measures during that time.
Additional Information: [Additional Information]
7. INTERACTIVE PROCESS
I acknowledge that the ADA requires both the employer and employee to engage in an interactive process in good faith to identify an effective, reasonable accommodation (29 CFR §1630.2(o)(3); EEOC Enforcement Guidance on Reasonable Accommodation, 2002). I am fully prepared to participate in this process and to provide any additional information, including medical documentation, necessary to evaluate this request.
Please contact me at [Employee Phone] or [Employee Email] to schedule a meeting or to request further information. I request a written response to this accommodation request within a reasonable timeframe.
8. CERTIFICATION
I certify that the information provided in this request is true, accurate, and complete to the best of my knowledge. I am making this request in good faith pursuant to my rights under the Americans with Disabilities Act of 1990, as amended, and applicable EEOC regulations.
Employee Signature: ______________________________
Printed Name: [Employee Name]
Date: [Signature Date]
FOR HR USE ONLY:
Date Received: _______________
Received By: _______________
Tracking Number: _______________
Employee
________________
Signature
Date: ________________
What Is a ADA Reasonable Accommodation Request?
An ADA Reasonable Accommodation Request in the United States puts a formal request before the recipient and sets out the grounds supporting it.
Under the ADA, a covered employer — one with 15 or more employees — is prohibited from discriminating against a qualified individual with a disability and is required to provide reasonable accommodations unless doing so would impose an undue hardship on the business. A reasonable accommodation is any modification or adjustment to a job, work environment, or the way things are usually done that enables a qualified person with a disability to enjoy equal employment opportunities. Examples include modified work schedules, ergonomic equipment, remote work arrangements, reassignment of marginal job functions, leave under the FMLA, accessible parking, and modified training materials.
The accommodation request is not merely a courtesy — it is the legal trigger that obligates the employer to act. Courts have consistently held that employers are not required to provide accommodations they do not know are needed. By submitting a formal written request, the employee creates a dated record that starts the clock on the employer's interactive process obligation under 29 CFR §1630.2(o)(3). EEOC enforcement guidance emphasizes that the interactive process must begin promptly and proceed in good faith by both parties.
The ADAAA of 2008 was enacted in direct response to two Supreme Court decisions — Toyota Motor Manufacturing v. Williams (2002) and Sutton v. United Air Lines (1999) — that had interpreted the definition of disability so narrowly that few conditions qualified. The ADAAA rejected those interpretations and reinstated the ADA's original broad protective intent. As a result, conditions including diabetes, cancer in remission, epilepsy, major depression, PTSD, HIV infection, and many chronic conditions now routinely qualify under the ADA even when controlled by medication or treatment.
When Do You Need a ADA Reasonable Accommodation Request?
You should submit a formal ADA Reasonable Accommodation Request whenever a physical or mental condition substantially limits your ability to perform one or more of your essential job functions, and you need some modification to the workplace, schedule, equipment, or policy to address that limitation. The request is necessary — and often urgent — in several common situations.
New disability or worsening condition: If you are newly diagnosed with a disability or your existing condition has worsened to the point that it now significantly affects your work performance, you should submit a request as soon as practicable. Courts have held that unreasonable delay in requesting accommodations can complicate your legal position.
Return from medical leave: If you are returning from FMLA or other medical leave with ongoing limitations, an accommodation request ensures the employer knows what adjustments you need to continue working effectively. Without a formal request, the employer may not know you need assistance.
Performance issues caused by disability: If your disability is causing performance problems — such as absenteeism due to a chronic condition, difficulty concentrating due to a mental health condition, or physical limitations affecting productivity — an accommodation request stops the performance management clock. An employer cannot lawfully terminate an employee for disability-related performance issues if the employer failed to engage in the accommodation process.
Pre-emptive accommodation for a new role: If you are accepting a job offer or being transferred to a new position with different physical or cognitive demands, you may need to request accommodations before your start date.
The request should always be in writing. Verbal requests can be forgotten, disputed, or never formally processed. A written, signed, and dated document creates an unambiguous record of when the request was made, what was requested, and who received it — all critical facts in any future EEOC charge or litigation under the ADA.
What to Include in Your ADA Reasonable Accommodation Request
A well-drafted ADA Reasonable Accommodation Request should contain several essential components that establish the legal foundation for your request and help the interactive process.
Employee and employer identification: The document should clearly identify you by full name, job title, department, and employee ID, and should be addressed to the specific HR manager, HR director, or supervisor with authority to act on accommodation requests. Addressing the letter to a specific, named individual reduces the risk of it being lost or ignored.
Description of the disability and functional limitations: You do not need to disclose your specific diagnosis, but you must describe the nature of your impairment and how it substantially limits one or more major life activities as defined in 42 U.S.C. §12102. Be specific about how the condition affects your ability to perform the essential functions of your particular job — this is the key legal connection the EEOC looks for.
Specific accommodation request: Clearly describe the accommodation(s) you are seeking. Vague requests like 'I need help' are difficult for employers to act on. Instead, specify the adjustment needed: a standing desk, modified schedule, permission to work from home on certain days, a reassignment of a particular duty, or a leave of absence. If you are uncertain what accommodation would work best, you may request that the employer engage in the interactive process to identify options together.
Explanation of effectiveness: Connect the requested accommodation to your ability to perform your essential job functions. This demonstrates that the accommodation is directed at enabling you to do your job — not simply to receive a benefit — which is the legal standard under the ADA.
Medical documentation reference: While you do not attach your full medical records, indicate whether you are providing supporting documentation from your healthcare provider, and identify the provider. EEOC guidance states that employers may request documentation sufficient to establish the disability and functional limitations, but may not demand your entire medical history.
The forms-legal.com ADA Reasonable Accommodation Request template includes all six sections — employee identification, disability description, functional limitations, specific accommodation requested, medical documentation reference, and dated signature — aligned with EEOC guidance and 29 CFR Part 1630 requirements.
Date and signature: A dated, signed request is significantly stronger than an undated or unsigned one. The date establishes when the employer's interactive process obligation was triggered under 29 CFR §1630.2(o)(3). Keep a copy of every accommodation request you submit.
Sources & Citations
Statutory citations link to official government sources.
- 42 U.S.C. §12102US – Cornell LII
- 29 CFR §1630.2US – eCFR
- ADAUS – Cornell LII
- FMLAUS – Cornell LII
Cite this page
Reference this free template in an article, syllabus, or research note:
Forms Legal. (2026). ADA Reasonable Accommodation Request (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/employment/forms/ada-accommodation-request
"ADA Reasonable Accommodation Request (United States)." Forms Legal, 2026, https://forms-legal.com/usa/employment/forms/ada-accommodation-request.
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year = {2026},
howpublished = {\url{https://forms-legal.com/usa/employment/forms/ada-accommodation-request}},
note = {Free legal document template. Based on Americans with Disabilities Act (42 U.S.C. §12101)}
}Frequently Asked Questions
Under 42 U.S.C. §12102, as broadened by the ADA Amendments Act of 2008 (ADAAA), a disability is defined as a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or being regarded as having such an impairment. The ADAAA was enacted by Congress specifically to overturn the narrow interpretations adopted by the U.S. Supreme Court in Toyota Motor Manufacturing v. Williams (2002) and Sutton v. United Air Lines (1999), which had excluded many conditions from ADA protection. Major life activities under 42 U.S.C. §12102(2) include walking, seeing, hearing, speaking, breathing, learning, concentrating, thinking, communicating, and working, as well as major bodily functions such as immune system function, cell growth, and neurological and endocrine functions. Conditions including cancer (even in remission), diabetes, epilepsy, PTSD, major depressive disorder, HIV infection, autism spectrum disorders, and many chronic conditions now routinely qualify under the ADA even when controlled by medication or mitigating measures.
Under 42 U.S.C. §12112(b)(5)(A), United States employers with 15 or more employees must provide an effective reasonable accommodation, but the ADA does not require the employer to grant the specific accommodation the employee requests. The employer may offer an alternative accommodation that effectively enables the employee to perform the essential functions of the position. The EEOC Enforcement Guidance on Reasonable Accommodation (revised 2002) states that the employer should give primary consideration to the employee's preferred accommodation, but the employer retains the right to choose among effective alternatives. An employer may deny a requested accommodation if it would impose an undue hardship under 42 U.S.C. §12111(10), defined as an action requiring significant difficulty or expense when considered against factors including the employer's overall financial resources, facility size, and the nature and cost of the accommodation. The employer's obligation throughout the process is to engage in the interactive process in good faith under 29 CFR §1630.2(o)(3) and to document why an alternative accommodation was selected if the employee's preferred option is denied.
An employee in the United States requesting an ADA accommodation is not required to disclose a specific medical diagnosis to the employer. Under EEOC guidance and 29 CFR Part 1630, the employee must provide sufficient information to establish that a disability exists as defined by 42 U.S.C. §12102 and that the disability creates a functional limitation affecting the ability to perform essential job functions. The employer may request supporting documentation from the employee's healthcare provider, but that request must be limited to information necessary to verify the existence of the disability and the nature of the functional limitations — the employer cannot demand the employee's complete medical history, unrelated treatment records, or genetic information protected under the Genetic Information Nondiscrimination Act (GINA, 42 U.S.C. §2000ff). All medical information obtained during the accommodation process must be kept confidential under 29 CFR §1630.14(d), maintained in separate medical files apart from the employee's personnel file, and disclosed only to supervisors and managers on a need-to-know basis regarding necessary restrictions and accommodations.
The interactive process, described in 29 CFR §1630.2(o)(3) and detailed in EEOC enforcement guidance, is an informal, collaborative dialogue between the employee and employer to identify an effective reasonable accommodation under the Americans with Disabilities Act. Once an employee submits a written accommodation request, the employer is legally obligated to initiate this process promptly and conduct it in good faith. The interactive process typically involves identifying the essential functions of the employee's position, determining the precise job-related limitations caused by the disability, exploring potential accommodations with input from both parties, and assessing whether any proposed accommodation would impose an undue hardship on the employer under 42 U.S.C. §12111(10). Federal courts — including the Second, Third, Seventh, and Ninth Circuits — have held that an employer's failure to engage in the interactive process can constitute a violation of the ADA if the failure prevented identification of an accommodation that would have been effective and reasonable. Employees who also need medical leave should consider submitting a separate FMLA leave request form, as FMLA and ADA obligations operate concurrently.
Retaliation against an employee for requesting a reasonable accommodation is expressly prohibited under 42 U.S.C. §12203(a) of the Americans with Disabilities Act in the United States. The anti-retaliation provision makes it unlawful for an employer to discharge, demote, reduce hours, harass, transfer to a less desirable position, or otherwise discriminate against an employee for exercising rights under the ADA, including filing an accommodation request, participating in the interactive process, or filing an EEOC charge. The U.S. Supreme Court confirmed in Burlington Northern & Santa Fe Railway Co. v. White (2006) that retaliation claims cover any employer action that would dissuade a reasonable employee from exercising their rights, not just actions affecting the terms and conditions of employment. Employees who experience retaliation may file a charge with the Equal Employment Opportunity Commission (EEOC) within 180 days of the retaliatory act, or within 300 days in states that have a Fair Employment Practices Agency with a worksharing agreement with the EEOC. Documentation of retaliatory conduct — including dates, witnesses, and written communications — strengthens any subsequent complaint.
The Americans with Disabilities Act does not set a specific deadline in days for an employer to respond to an accommodation request in the United States. The EEOC's Enforcement Guidance on Reasonable Accommodation and Undue Hardship states that employers must act promptly, and unnecessary delay in responding to or implementing a reasonable accommodation may constitute a violation of the ADA. Federal courts have found delays of several weeks to several months unreasonable depending on the circumstances, particularly when the accommodation requested is straightforward (such as providing an ergonomic chair or adjusting a work schedule) and the employer had no legitimate reason for the delay. The Seventh Circuit in Gile v. United Airlines (2000) held that an employer's unexplained 8-month delay in processing an accommodation request violated the ADA. Factors courts consider include the complexity of the accommodation, whether the employer needed to obtain additional medical documentation, whether the interactive process was ongoing, and whether the employer communicated with the employee about the status. Employers should acknowledge receipt of the request within a few business days and provide a substantive response — either granting the accommodation, proposing alternatives, or requesting additional documentation — within two to four weeks.
This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer
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