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Reasonable Accommodation Request - IRS Careers

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Form13661 (Rev. 7-2005) Catalog Number 39619XDepartment of the Treasury - Internal Revenue ServiceReasonable Accommodation RequestPart IWritten Reasonable Accommodation RequestTo be completed by applicant for employment, employee, or personnelmanagement specialist to document Reasonable Accommodation IIDeciding Official DocumentationTo be completed by Deciding Official for use in information trackingpurposes. Part II, Items 5, 6, and 7, may be provided to Health CarePractitioner, Social Worker, or Rehabilitation Counselor as supplementalinformation.

Reasonable Accommodation Request Part I Written Reasonable Accommodation Request To be completed by applicant for employment, employee, or personnel management specialist to document reasonable accommodation request. Part II Deciding Official Documentation To be completed by Deciding Official for use in information tracking purposes.

  Request, Reasonable, Accommodation, Reasonable accommodation request

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