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AHRQ Procedures for Providing Reasonable Accommodation for Individuals With Disabilities

The Agency for Healthcare Research and Quality (AHRQ) has developed these reasonable accommodation procedures in compliance with Equal Employment Opportunity Commission (EEOC) guidance and consistent with the Department of Health and Human Services (HHS) document "Procedures for Providing Reasonable Accommodation for Individuals With Disabilities."

Policy on Reasonable Accommodation

It is the policy of AHRQ to provide equal opportunity to all qualified individuals with disabilities (in accordance with the Rehabilitation Act of 1973) and to fully comply with other legal and regulatory requirements to ensure that all aspects of employment are made fully accessible to all employees, and all aspects of the application process are fully accessible to all applicants. No qualified employee with a disability may be denied the benefits of a program, training, or activity conducted, sponsored, funded, or promoted by AHRQ, or otherwise be subjected to discrimination. To this end, reasonable accommodations will be provided to qualified individuals with disabilities, unless doing so poses an undue hardship to the Agency.

To fulfill its commitment to ensure that individuals with disabilities enjoy full access to equal employment opportunity, AHRQ provides reasonable accommodation in the following areas:

When an applicant with a disability needs an accommodation in order to apply or be interviewed for a job.
When an employee with a disability needs an accommodation in order to perform the essential functions of the job or to gain access to the workplace.
When an employee with a disability needs an accommodation to enjoy equal benefits and privileges of employment.

AHRQ employees may refer to the EEOC's "Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans With Disabilities Act" (available at http://www.eeoc.gov/policy/docs/accommodation.html) for additional information on the rights and responsibilities of applicants and employees requesting reasonable accommodation, and the responsibilities of AHRQ personnel involved in responding to those requests.

AHRQ may take steps, when appropriate, beyond those required by the reasonable accommodation process in this document or in the EEOC guidance.

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Definition of Key Terms

Reasonable accommodation: Any change in the work environment or in the way things are customarily done that would enable a qualified individual with a disability to enjoy equal employment opportunities.
Disability: Includes the following:
- A physical or mental impairment that substantially limits one or more of an individual's major life activities. Examples of major life activities include, but are not limited to, caring for oneself, walking, seeing, hearing, speaking, breathing, learning, sitting, standing, lifting, and working, as well as mental and emotional processes such as thinking, concentrating, and interacting with others. This list is constantly changing based on statutory changes and case law.
- A record of such an impairment.
- A perception as having such an impairment.
Qualified individual with a disability: An individual with a disability is qualified if he or she 1) satisfies the requisite skills, experience, education, and other job related requirements of the position and 2) can perform the essential functions of the position, with or without reasonable accommodation.
Essential functions: The job duties that are so fundamental to a position that the job cannot be done without performing them. A function can be essential if, among other things, the position exists specifically to perform that function, there are a limited number of other employees who could perform the function, or the function is specialized and the individual is hired based on his or her ability to perform it. Determination of essential functions must be done on a case-by-case basis so that it reflects the job as actually performed, and not simply the components of a generic position description.
Reassignment: Reassignment is a form of reasonable accommodation that is provided to employees who, because of a disability, can no longer perform the essential functions of their current position, even with reasonable accommodation. Reassignment is available only to an existing employee who is qualified for the new position; it is not available to new applicants. Reassignment is made only to existing positions in HHS as a whole. An employee qualified for the position can be reassigned to the job without competing for it.
Undue hardship: If a specific type of reasonable accommodation causes significant difficulty or expense to the Agency, meaning HHS, AHRQ is not required to provide that particular accommodation. Determination of undue hardship is always made on a case-by-case basis, considering factors such as the nature and cost of the reasonable accommodation needed and the impact of the reasonable accommodation on the organization's operations.

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Responsibility

It is the responsibility of the Agency to provide reasonable accommodation in accordance with the guidelines prescribed by the Americans With Disabilities Act (ADA) and EEOC.

The responsibilities for each part of the reasonable accommodation are explained in the following section of this document.

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Procedures for Responding to Requests for Reasonable Accommodation

A request for reasonable accommodation is a statement that an individual needs an adjustment or change at work, in the application process, or in a benefit or privilege of employment for a reason related to a medical condition. The reasonable accommodation process begins as soon as the request for the change or identification of a barrier is made, whether orally or in writing.

A request does not have to use any special terms, such as "reasonable accommodation," "disability," or "Rehabilitation Act." Individuals with a disability may request a reasonable accommodation whenever they choose, even if they have not previously disclosed the existence of a disability. Any AHRQ employee or applicant may consult a member of the Reasonable Accommodation Team or other designee for further information or assistance in connection with requesting or processing a request for reasonable accommodation.

Employees may request reasonable accommodation orally or in writing from their supervisor, another supervisor or manager in their immediate chain of command, their Office Director, or a member of the Reasonable Accommodation Team or other designee. Accommodation will be provided in recurring situations without requiring a new request from the employee each time.
Applicants may request reasonable accommodation orally or in writing from any AHRQ employee with whom they have contact in connection with the application process.
Family members, health professionals, or other representatives may request reasonable accommodation on behalf of an employee or applicant. The request should be made to one of the same persons to whom an employee or applicant would make the request. Whenever possible, AHRQ staff will confirm the request with the person with the disability.

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Determining Which Official Will Respond to the Request

As the first step in processing a request for reasonable accommodation, the AHRQ staff member who receives the request must determine who will be responsible for handling and forwarding the request, if necessary. The person who responds to the request for accommodation will be referred to as the "decisionmaker." There are four possible decisionmakers: a Human Resources Specialist (for applicants), an employee's supervisor, an employee's Office Director or other official in that chain of command, or the appropriate support official (i.e., Facilities, Information Technology). The staff member who receives a request for accommodation should follow the instructions below to determine which of these individuals should receive the request.

The request should be forwarded to the appropriate person as soon as possible, but no later than 5 business days.¹

Requests for accommodation from applicants will be processed by a Specialist from the Food and Drug Administration's (FDA's) Office of Equal Employment Opportunity and Diversity Management (OEEODM). The Specialist acting as decisionmaker should document and track all reasonable accommodation requests and activities.
Requests for accommodation from employees will be processed by the immediate supervisor, unless the request is one that should be referred to an Office or Center Director or a member of the OEEODM's Reasonable Accommodation Team, as explained below.
Certain requests for accommodation will be referred to the Office Director or other designee. These include requests involving personnel actions (other than reassignment). In this case, the decisionmaker should document and track all reasonable accommodation activities.
Certain requests for accommodation will be referred to a member of the FDA OEEODM Reasonable Accommodation Team or other designee. This individual will respond to the following requests and identify the appropriate decisionmaker to refer the request to:
- Requests for adaptive equipment, including information technology and communications equipment, or specially designed furniture.
- Requests for a reader, sign language interpreter, or other personal assistant to enable employees to perform their job functions, when the accommodation cannot be provided by current staff.
- Request for removal of architectural barriers, including reconfigured work spaces.²
- Requests for accessible parking will be handled through each Office/Center's internal procedures. Information on these accommodations shall be documented and included in the reports of all reasonable accommodations.
- Requests for materials in alternative formats (e.g., Braille) that cannot be provided by the supervisor or Office/Center Director.
- Requests for reassignment to another job, in coordination with the human resources services provider.
In addition, the Reasonable Accommodation Specialist or other designee will be available, as needed, to provide assistance to employees and decisionmakers in processing requests. At no time will the Reasonable Accommodation Specialist be the decisionmaker for any reasonable accommodation request.
All decisionmakers, as well as the Reasonable Accommodation Specialist, must have designated backups to continue receiving and processing requests and providing reasonable accommodations when the decisionmaker is unavailable. Decisionmakers should ensure that the requesting individual knows who has been designated as a backup. The time frames discussed in the next section will not be suspended or extended due to the unavailability of a decisionmaker.
- The backup for a supervisor is the Office/Center Director.
- The Human Resources Specialist (for applicants), the Office/Center Director, and the Reasonable Accommodation Specialist or other designee assigned to the case must each designate a backup.

^1. In certain circumstances, referring and processing a request will have to be done quickly. For example, an applicant may need an accommodation immediately, such as help with filling out an application form.
^2. If a request that involves removal of an architectural barrier is not feasible, the employee should be provided a reasonable accommodation until or in lieu of removal of the barrier.

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Time Frames for Processing Requests and Providing Reasonable Accommodation

AHRQ will process requests and provide reasonable accommodation, as appropriate, in as short a time frame as possible. The Agency recognizes that the time necessary to process a request will depend on the nature of the accommodation requested and whether there is a need to obtain supporting information.

Expedited Processing

In certain circumstances, a request for reasonable accommodation requires an expedited review and decision in a time frame that is shorter than 10 business days.

This includes when a reasonable accommodation is needed to enable an applicant to apply for a job. Depending on the timetable for receiving applications, conducting interviews, administering tests, and making hiring decisions, there may be a need to expedite a request for reasonable accommodation in order to ensure that an applicant with a disability has an equal opportunity to apply for a job. Therefore, FDA staff should act as quickly as possible to make a decision and, if appropriate, provide reasonable accommodation.
This also includes when a reasonable accommodation is needed to enable an employee to attend a meeting or event that will soon occur. For example, an employee may need a sign language interpreter for a meeting within a short time frame.

If a request for an accommodation can be processed by the requesting employee's supervisor or Office/Center Director, no supporting medical information is required, and no extenuating circumstances apply, the decision should be given to the employee as soon as possible, but no more than 15 business days from the date of request. The accommodation, if granted, should be provided within 10 business days from the date of approval, unless there are extenuating circumstances. Items that must be ordered from nonlocal sources may take longer than the 10-day limit. However, officials should move quickly to comply with requests, because failure to respond promptly to a request may result in a violation of the Rehabilitation Act. Since decisionmakers may need the full 15 business days to engage in the interactive process and collect all relevant information about possible accommodations, they should not delay beginning this process. Failure to meet this time frame solely because a decisionmaker delayed processing the request is not an extenuating circumstance.

If the decisionmaker believes that it is necessary to obtain medical information to determine whether the requesting individual has a disability and/or to identify the functional limitations, the decisionmaker will make such request to the Reasonable Accommodation Specialist or other designee as soon as possible after receipt of the request for accommodation, but before the 15-day period ends. AHRQ recognizes that the need for documentation may not become apparent until after the interactive process has begun.
If the decisionmaker requests that the Reasonable Accommodation Specialist or other designee obtain medical information, the time period for the decision process is frozen until the medical information is provided. If the Reasonable Accommodation Specialist or other designee determines that medical information is not needed, he or she will notify the decisionmaker and the 15-day time period for processing the request will resume.
If the Reasonable Accommodation Specialist or other designee determines that medical documentation is needed, the decision shall be made and the accommodation, if granted, will be provided within 15 business days from the date the decisionmaker receives the relevant medical information.

Examples of accommodations that can be provided immediately include:

An employee with diabetes who sits in an open area asks for four breaks a day to test his blood sugar level in private.
An employee with a disability that affects arm strength requests that certain files in her office be moved from the overhead storage to the desktop.

Examples of accommodations that can easily be provided within 2 business days include:

An employee who takes an antidepressant medication that makes it hard to wake up in time to get to the office at 9:00 a.m. requests to start work at 10:00 a.m. and work an 8-hour day.
A supervisor distributes a detailed agenda at the beginning of each staff meeting. An employee with a learning disability asks that the agenda be distributed ahead of time because his disability makes it difficult to read the agenda, and he needs more time to prepare.

Extenuating Circumstances

When extenuating circumstances are present, the time for processing a request for reasonable accommodation and providing the accommodation will be extended as necessary. All AHRQ staff is expected to act quickly in processing requests and providing accommodations. The following list, while not exhaustive, outlines examples of extenuating circumstances:

There is an outstanding initial or followup request for medical information.
Purchase of equipment may take longer than 15 or 20 business days because of requirements under Federal Acquisition Regulations.
Equipment is on back order, the vendor typically used for goods or services has gone out of business, or the vendor cannot promptly supply the needed goods or services and another vendor is not immediately available.
New staff needs to be hired or architectural barriers must be removed.

Extenuating circumstances cover limited situations in which unforeseen or unavoidable events occurring outside of the Agency's control prevent the prompt processing and delivery of an accommodation. For example, AHRQ staff may not delay processing or providing an accommodation because a particular staff member is unavailable.

When extenuating circumstances exist, the decisionmaker must notify the requesting individual of the reason for the delay and the approximate date on which a decision, or provision of the reasonable accommodation, is expected. Any further developments or changes should also be communicated promptly to the individual. The following list, while not exhaustive, outlines examples of delays and possible temporary measures that can be taken:

If there is a delay in providing an approved accommodation, the decisionmaker must determine if temporary measures can assist the employee. This could include providing the requested accommodation on a temporary basis or providing a less effective form of accommodation. In addition, the decisionmaker may provide measures that do not constitute reasonable accommodation within the meaning of the law (e.g., temporary removal of an essential function) if: 1) the measures do not interfere with the operations of the Agency and 2) the employee is clearly informed that the measures are being provided only on a temporary, interim basis.
There may be a delay in receiving adaptive equipment for an employee with a vision disability. The supervisor might arrange for other employees to act as readers as a temporary measure. This may not be as effective as the adaptive equipment, but it will allow the employee to perform as much of the job as possible until the equipment arrives.
If a delay is attributable to the need to obtain or evaluate medical documentation and the Agency has not yet determined that the individual is entitled to an accommodation, an accommodation may be provided on a temporary basis. In such a case, the decisionmaker will notify the individual in writing that the accommodation is being provided on a temporary basis, pending a decision on the accommodation request.
AHRQ decisionmakers who approve such temporary measures are responsible for ensuring that they do not take the place of permanent accommodation and that all necessary steps to secure permanent accommodation are being taken.

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Responding to Requests for Reasonable Accommodation: The Interactive Process

The interactive process determines what, if any, accommodation should be provided. This means that the individual requesting the accommodation and the decisionmaker must talk to each other about the request, the process for determining whether an accommodation will be provided, and the potential accommodation.

Communication is a priority throughout the entire process. The AHRQ decisionmaker will have the principal responsibility for identifying possible accommodations. The decisionmaker will take a proactive approach in researching and considering possible accommodations, including consulting appropriate resources for assistance. The employee requesting accommodation should also participate to the extent possible in helping to identify effective accommodation. The Reasonable Accommodation Specialist or other designee should also be available to provide assistance.

As the first step, the AHRQ decisionmaker will 1) acknowledge the request, 2) explain to the applicant or employee who will be making the decision on the request, and 3) describe what will happen in the processing of the request. This initial discussion should take place as soon as possible.
When a request for accommodation is made by a third party, the decisionmaker should, if possible, confirm with the applicant or employee that he or she, in fact, wants a reasonable accommodation before proceeding. It may not be possible to confirm the request if the employee has, for example, been hospitalized in an acute condition. In this situation, AHRQ staff will process the third party's request and consult directly with the individual needing the accommodation as soon as it is practicable.
Ongoing communication is particularly important when the specific limitation, problem, or barrier is unclear; an effective accommodation is not obvious; or the involved parties are considering different possible reasonable accommodations. In cases where the disability, the need for accommodation, and the type of accommodation to be provided are clear, extensive discussions are not necessary. Every reasonable accommodation is provided on a case-by-case basis. The accommodation that suits one individual may be unsuitable for another individual with the same disability. The decisionmaker and requesting individual should communicate to ensure a full exchange of relevant information.
The decisionmaker or any other AHRQ official who receives information in connection with a request for reasonable accommodation may share information about that request with other Agency officials only when they need to know the information in order to make determinations on a reasonable accommodation request. The decisionmaker should notify the FDA Reasonable Accommodation Specialist in OEEODM to obtain guidance, as necessary, to ensure that the proper procedures have been followed.
The AHRQ Office that manages information resources or information technology may be consulted in connection with requests for adaptive equipment for computers. However, this Office has no need to know the medical condition of the person seeking the accommodation. It only needs to know the individual's functional limitations and how the limitations affect technology needs. HHS now has an Interagency Agreement with the Computer/Electronic Accommodations Program to provide assistive technology, devices, and services to HHS employees with disabilities at no cost.

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Written Requests for Recordkeeping Purposes

To enable HHS and AHRQ to maintain accurate records regarding requests for accommodation, employees seeking a reasonable accommodation are asked to follow an oral request by confirming their request in writing (including E-mail) to the FDA Reasonable Accommodation Specialist or other designated decisionmaker. If an individual with a disability requires assistance with this requirement, the staff member who receives the request will provide that assistance.

While the written confirmation should be made as soon as possible following the initial request, it is not required before the request can be processed. AHRQ staff will begin processing the request as soon as it is made, whether or not the written confirmation has been provided.

A written confirmation is not required when an individual needs a reasonable accommodation on a repeated basis (e.g., the assistance of sign language interpreters or readers). The written confirmation is required only for the first request, although appropriate notice must be given each time the accommodation is needed.

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Requests for Medical Information

When requests for medical information are necessary, the only information that should be requested is: a short description of the disability, how the disability or barrier limits the employee's ability to do the job or participate in AHRQ activities or the applicant's ability to apply or interview for the job, and how the requested accommodation is expected to improve the situation.

AHRQ is not required to obtain medical documentation, and may not request it when the disability and need for accommodation are obvious or already on file at the Agency. In these cases, the Agency will not seek any further medical information. However, when a disability and/or need for reasonable accommodation is not obvious or already on file, the Agency has the right to request relevant documentation about the disability, functional limitations related to the duties at issue, and the need for accommodation. The request should be limited to the job related functions for which the accommodation is requested. In most situations, this means that AHRQ staff may not request access to a person's complete medical records, because they likely contain information unrelated to the disability at issue and the need for accommodation.

If a decisionmaker believes that medical information is necessary in order to evaluate the suitability of the requested reasonable accommodation, he or she will make a request to the FDA Reasonable Accommodation Specialist or other designee to obtain the information. The Reasonable Accommodation Specialist or other designee will make a determination as to whether medical documentation is necessary. If it is, he or she will request the necessary medical information. If it is not necessary, the request for accommodation will be returned promptly to the decisionmaker with instructions to complete the processing of the request.

If a determination is made to seek medical information, the Reasonable Accommodation Specialist will request information only to substantiate that the individual has a disability covered by the Rehabilitation Act and needs the reasonable accommodation requested; he or she will not ask for unrelated documentation. Requests for medical information will follow the requirements set forth in EEOC's "Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees Under the Americans With Disabilities Act" (available at http://www.eeoc.gov/policy/docs/guidance-inquiries.html). The Reasonable Accommodation Specialist or other designee will seek information or documentation about the disability and/or functional limitations from the individual, and/or ask the individual to obtain such information from an appropriate professional, such as a doctor, social worker, or rehabilitation counselor. In order to receive the most helpful information possible, all requests for information from outside sources will describe the nature of the job, the essential functions that the individual is expected to perform, and any other relevant information. The Reasonable Accommodation Specialist or other designee may work with the supervisor and/or Office Director in identifying and providing appropriate information about the job and its functions.

Once the medical documentation is received, the Reasonable Accommodation Specialist or other designee will evaluate the information, in consultation with a medical consultant, if necessary. This evaluation will be performed at the Agency's expense. If the information provided by the health care professional (or the information volunteered by the individual requesting the accommodation) is insufficient to enable the Reasonable Accommodation Specialist to determine whether an accommodation is appropriate, he or she may request additional information.

First, the Reasonable Accommodation Specialist or other designee will explain to the individual seeking the accommodation, in specific terms, why the information provided is insufficient, what additional information is needed, and why it is necessary for a determination of the reasonable accommodation request.
The individual requesting accommodation may then contact the health care professional or other appropriate professional to request the missing information.
Alternatively, the individual requesting the accommodation and the Reasonable Accommodation Specialist or other designee may agree on a list of specific questions to be sent to the individual's health care professional. With the agreement of the individual, the Reasonable Accommodation Specialist or other designee may directly contact the individual's health care professional.
If, after a reasonable period of time, the individual's health care professional has not provided sufficient information to demonstrate that the individual has a disability and needs reasonable accommodation, the Reasonable Accommodation Specialist or other designee may request that the individual be examined by a physician chosen by AHRQ, at the Agency's expense.

The Reasonable Accommodation Specialist or other designee will let the decisionmaker know whether the documentation demonstrates that a reasonable accommodation is appropriate and provide, as necessary, additional relevant information about the individual's functional limitations. In some cases, the individual requesting the accommodation will supply medical information directly to the decisionmaker without being asked. In these cases, the decisionmaker will consider such documentation and, if additional information is needed, the decisionmaker will work with the Reasonable Accommodation Specialist or other designee as set forth in this section. Failure to provide appropriate documentation or to cooperate with the Agency's efforts to obtain such documentation can result in a denial of the reasonable accommodation request.

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Confidentiality Requirements Regarding Medical Information and the Reasonable Accommodation Process

Under the Rehabilitation Act, medical information obtained in connection with the reasonable accommodation process must be kept confidential. All medical information, including information about functional limitations and reasonable accommodation needs, obtained in connection with a request for reasonable accommodation must be kept in files separate from the individual's personnel file. Any AHRQ employee who obtains or receives such information is strictly bound by these confidentiality requirements.

The FDA OEEODM will designate who will maintain custody of all records obtained or created during the processing of a request for reasonable accommodation, including medical records, and will respond to all requests for disclosure of the records. All records will be maintained in accordance with the Privacy Act and EEOC and HHS requirements.
This information may be disclosed only as follows:
- Supervisors and managers who need to know (including the decisionmaker who requested that the medical information be obtained) may be told about necessary restrictions on the work or duties of the employee and about the necessary accommodation, but medical information should only be disclosed if strictly necessary.
- First aid and safety personnel may be informed, when appropriate, if the disability might require emergency treatment.
- Government officials may be given information necessary to investigate compliance with the Rehabilitation Act.
- Information may in certain circumstances be disclosed to a worker's compensation office or insurance carriers.

Whenever medical information is disclosed, the individual who discloses the information must inform the recipients of the information about the confidentiality requirements that are attached.

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Provisions of Accommodation: Funding

The source of funding for reasonable accommodation requests should be provided at the Office/Center level. Decisionmakers are responsible for seeking out funding for the provisions of accommodations within their respective area.

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Reassignment

Reassignment will only be considered if no other accommodation enables the individual to perform his or her current job, or if the only effective accommodation would cause undue hardship for the Agency. Reassignment is available only to employees, not to applicants. AHRQ is not required to create new positions or move employees from their jobs to create a vacancy.

In considering whether there are positions available for reassignment, the FDA Reasonable Accommodation Specialist or other designee will work with both the human resources service provider and the individual requesting the accommodation to identify: 1) all vacant positions within the Agency for which the employee may be qualified, with or without reasonable accommodation, and 2) all positions that the Division of Human Capital Resources Management has reason to believe will become vacant over the next 60 business days and for which the employee may be qualified. It must be noted that when discussing reassignment, the term "Agency" refers to HHS. AHRQ will first focus on positions that are equivalent to the employee's current job in terms of pay, status, and other relevant factors. If there is no vacant equivalent position, the organization will consider vacant lower-level positions for which the individual is qualified.

Reassignment may be made to a vacant position outside of the employee's commuting area if the employee is willing to relocate. As with other transfers not required by management, AHRQ will not pay for the employee's relocation costs.

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Granting the Reasonable Accommodation Request

As soon as the decisionmaker determines that reasonable accommodation will be provided, the decision should be immediately communicated to the individual. If the accommodation cannot be provided immediately, the decisionmaker must inform the individual of the projected time frame for providing the accommodation. This notice can be provided in writing if it is requested by the employee.

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