Form SF 256 PDF Details

The SF 256 form, titled "Self-Identification of Disability," serves a pivotal purpose within the Executive Branch of the Federal government, which has committed to enhancing the hiring, placement, and advancement prospects for individuals with disabilities. This form invites employees to voluntarily self-disclose any disabilities or serious health conditions they have from a comprehensive list that includes but is not limited to developmental disabilities, traumatic brain injuries, sensory impairments (such as serious difficulty hearing or seeing), and various physical, intellectual, and mental health conditions. The provision of this information is crucial for the government to gather accurate data to assess and improve its disability employment programs, ensuring that individuals with disabilities are not only represented in the workforce but are also provided with equal opportunities for employment and advancement. There is an express assurance that any information provided will be treated with the utmost confidentiality, utilized solely for the purposes of facilitating appropriate workplace accommodations and for compiling reports aimed at evaluating and enhancing employment policies and practices for individuals with disabilities. By completing the SF 256, employees play a vital role in the government’s effort to foster an inclusive and diverse work environment. The form also highlights key legal frameworks, like the Rehabilitation Act of 1973, underscoring the government's commitment to this cause. Privacy concerns are directly addressed, with assurances that Social Security Numbers and personal information are collected with the highest standards of privacy in mind, emphasizing the voluntary nature of this disclosure, except in specific cases outlined by federal regulations. This initiative not only empowers employees with disabilities by acknowledging their need for potential accommodations but also contributes to the broader goal of creating an inclusive federal workforce.

QuestionAnswer
Form Name Form SF 256
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names sf 256, opm self identification, sf 256 disability, form sf 256

Form Preview Example

SELF- I DENTI FI CATI ON OF DI SABI LI TY

(Please read the Privacy Act information and additional instructions on Page 2)

Name (Last, First , Middle I nitial)

Date of Birth (MM/ YYYY)

Social Securit y Number

Purpose:

Each agency in the Executive Branch of t he Federal government has established programs t o facilitate the hiring, placement, and advancement of individuals with disabilities. Self-identification of disability status is essential for effective data collection and analysis of t he Federal government ’s efforts. While self-identification is voluntary, your cooperation in providing accurate information is critical to these efforts. Every precaution is taken to ensure that the information provided by each employee is kept in t he strictest confidence.

ENTER CODE HERE

Targeted Disabilities or Serious Health

Other Disabilities or Serious Health Conditions:

Conditions:

 

 

 

02- Developmental Disabilit y, for example, autism

13- Speech impairment

spectrum disorder

41- Spinal abnormalities, for example, spina bifida or scoliosis

03- Traumatic Brain I njury

44- Non-paralytic orthopedic impairments, for example,

19- Deaf or serious difficult y hearing, benefiting from,

chronic pain, stiffness, weakness in bones or joints, some

for example, American Sign Language, CART,

loss of ability to use part or parts of the body

hearing aids, a cochlear implant and/ or other

51- HI V Positive/ AI DS

supports

52- Morbid obesit y

20- Blind or serious difficult y seeing even when wearing

59- Nervous system disorder for example, migraine

glasses

headaches, Parkinson’s disease, or multiple sclerosis

31- Missing extremities (arm, leg, hand and/ or foot)

80- Cardiovascular or heart disease

40- Significant mobility impairment, benefiting from t he

81- Depression, anxiety disorder, or other psychiatric disorder

utilization of a wheelchair, scooter, walker, leg

83- Blood diseases, for example, sickle cell anemia,

brace(s) and/ or other supports

hemophilia

60- Partial or complete paralysis (any cause)

84- Diabetes

82- Epilepsy or ot her seizure disorders

85- Ort hopedic impairment s or osteo-arthritis

90- I ntellectual disability

86- Pulmonary or respiratory conditions, for example,

91- Significant Psychiatric Disorder, for example, bipolar

tuberculosis, ast hma, emphysema

disorder, schizophrenia, PTSD, or major depression

87- Kidney dysfunction

92- Dwarfism

88- Cancer (present or past history)

93- Significant disfigurement, for example,

94- Learning disability or attention deficit/ hyperactivit y

disfigurements caused by burns, wounds, accidents,

disorder (ADD/ ADHD)

or congenital disorders

95- Gastrointestinal disorders, for example, Crohn's Disease,

 

irritable bowel syndrome, colitis, celiac disease, dysphexia

 

96- Autoimmune disorder, for example, lupus, fibromyalgia,

Other Options:

rheumatoid arthritis

 

 

97- Liver disease, for example, hepatitis or cirrhosis

01- I do not wish to identify my disabilit y or serious

98- History of alcoholism or history of drug addiction ( but not

 

health condition.

currently using illegal drugs)

 

05- I do not have a disabilit y or serious health condition.

99- Endocrine disorder, for example, thyroid dysfunction

 

06- I have a disability or serious health condition, but it

 

is not listed on this form.

 

 

 

U.S. Office of Personnel Management

SF 256

 

Revised October 2016

 

Previous editions not usable

Page 1 of 2

Definit ion

An individual with a disability: A person who (1) has a physical or mental impairment which substantially limits one or more major life activities; ( 2) has a record of such an impairment; or (3) is regarded as having such an impairment . This definition is provided by the Rehabilitation Act of 1973, as amended (29 U.S.C. 701, et seq.) .

The Rehabilitation Act of 1973

The Rehabilitation Act of 1973, as amended (29 U.S.C. 701, et seq.), requires each agency in the Executive Branch of the Federal government to establish programs that will facilitate the hiring, placement, and advancement of individuals with disabilities. One met hod for determining agency progress in fulfilling these requirements is through the production of reports at certain intervals showing, for example, the number of employees with disabilities who are hired, promoted, trained, or reassigned over a given time period; the percentage of employees with disabilities in the work force and in various grades and occupations; et c. Such reports bring to t he attention of agency t op management, OPM, and t he Congress, the progress or any deficiencies within specific agencies or the Federal government as a whole in the hiring, placement, and advancement of individuals with disabilities.

The disability data collect ed on employees will be used only in t he production of reports such as those previously mentioned and not for any purpose that will affect them individually. The only exception to this rule is that the records may be used for selective placement purposes and selecting special populations for mailing of voluntary personnel research surveys. I n addition, every precaution will be taken to ensure t hat the information provided by each employee is kept in t he strictest confidence and is known only to those individuals in the agency Personnel Office, who obtain and record the information for entry into the agency’s and OPM’s personnel syst ems. You should also be aware that participation in the disability reporting system is entirely voluntary, with the exception of employees appoint ed under the Schedule A Excepted Appointing Authorit y for People with I ntellect ual Disabilit y, Severe Physical Disabilit y, or Psychiatric Disability (5 CFR 213.3102(u)) . Agencies will request that these employees identify t heir disability status and, if they decline to do so, t heir correct disability code will be obtained from medical documentation used to support their appointment .

Employees who wish to confirm the disability code carried in their agency’s and OPM’s personnel systems is consistent with the employees’ representation, may ask their Personnel Officer for a printout of the code and definition from t heir individual records. The code noted in the employees’ records in t he agencies’ system will be identical to that carried in OPM’s system.

Privacy Act Stat ement

Collection of the requested information is aut horized by the Rehabilitation Act of 1973, as amended (29 U.S.C. 701, et seq.) . Solicitation of your Social Security Number (SSN) is authorized by Executive Order 9397, which permits agencies to use the SSN as a means for identifying persons with disabilities in personnel information systems. Your SSN will only be used to ensure that your correct disability code is recorded along with other employee information that your agency and OPM maintain on you. I t should be noted, however, that where individuals decline to furnish their SSN, the SSN will be obtained from other records in order to ensure accurate and complete data. Employees appointed under the Schedule A Appointing Authorit y for People with I ntellectual Disability, Severe Physical Disability, or Psychiatric Disability (5 CFR 213.3102(u)) are requested to furnish an accurate disability code, but failure to do so will not affect them. Where employees hired under this authority fail to disclose their disability, the appropriate code will be determined from the employee’s existing records or medical documentation submitted upon appointment .

U.S. Office of Personnel Management

SF 256

 

Revised October 2016

 

Previous editions not usable

 

Page 2 of 2

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