VA Form 0857F PDF Details

Navigating the workplace can present unique challenges, especially when an employee requires accommodations to perform their job effectively due to a disability or medical condition. This is where the VA 0857F form, titled "Accommodation Request Determination," plays a crucial role. Aimed at employees within the VA (Veterans Affairs) system, this document serves as a formal response to requests for workplace accommodations. It's designed to communicate the decision made by the Designated Management Official (DMO) regarding such requests. Whether it’s to assist in applying for a job, performing essential job functions, or accessing employment benefits and privileges, the form outlines the specifics of the requested accommodation, including whether it has been approved, denied, or if an alternative solution is being offered. The form meticulously details the reasons for any denials, quoting the Rehabilitation Act’s definitions, and proposes next steps, including how employees can seek reconsideration or proceed with grievances through various channels including EEO complaints, union grievances, or administrative appeals. Additionally, it emphasizes the importance of prompt communication and the potential involvement in alternative dispute resolution (ADR) processes. This comprehensive approach ensures that all parties are well-informed of their rights and the reasoning behind any decisions made, thereby facilitating a more inclusive and accommodating workplace environment.

QuestionAnswer
Form NameVA Form 0857F
Form Length2 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out42 sec
Other names0857f, va form 0857a, accommodation request we sample, accommodation request would sample

Form Preview Example

ACCOMMODATION REQUEST DETERMINATION

1. NAME OF EMPLOYEE MAKING THE REQUEST

The purpose of this form is to inform you of our decision regarding your request for accommodation and to provide information to you. If our information is incorrect, please inform me as soon as possible.

2.

I AM THE DESIGNATED MANAGEMENT OFFICIAL (DMO) FOR THIS REQUEST.

MY CONTACT INFORMATION IS BELOW..

 

 

 

 

 

3.

MY NAME IS

4. MY PHONE NO. IS

 

5. MY EMAIL IS

 

 

 

 

 

6.YOUR REQUEST WAS MADE TO ENABLE YOU TO APPLY/INTERVIEW FOR A JOB,

PERFORM THE ESSENTIAL FUNCTIONS OF YOUR POSITION, OR

ACCESS A BENEFIT OR PRIVILEGE OF EMPLOYMENT.

7.YOU REQUESTED THE FOLLOWING ACCOMMODATION (Describe briefly)

8.YOUR REQUEST IS APPROVED, AND WILL BEGIN ON (Date)

9.ALTHOUGH WE ARE NOT PROVIDING THE ACCOMMODATION REQUESTED, WE ARE OFFERING AN ACCOMMODATION WHICH WE BELIEVE WOULD BE EFFECTIVE (Describe the alternative accommodation)

10. WE BELIEVE THIS ACCOMMODATION WOULD BE EFFECTIVE BECAUSE (Describe why you believe it will be effective)

11. YOUR ORIGINAL REQUEST WAS DENIED BECAUSE:

YOU DO NOT HAVE A DISABILITY COVERED BY THE REHABILITATION ACT

THE ACCOMMODATION REQUESTED WOULD NOT BE EFFECTIVE

THE ACCOMMODATION WOULD REQUIRE REMOVAL OF AN ESSTENTIAL FUNCTION OF THE JOB

THE MEDICAL DOCUMENTATION PROVIDED DID NOT SUPPORT THE REQUEST

THE ACCOMMODATION WOULD REQUIRE LOWERING OF A PERFORMANCE STANDARD OR PRODUCTION STANDARD

THE ACCOMMODATION WOULD CAUSE AN UNDUE HARDSHIP TO THE OPERATION OF THE UNIT

ALLOWING YOU TO WORK WOULD CREATE A DIRECT THREAT FOR YOU AND/OR OTHERS

VA FORM 0857F MAY 2013

12.DETAILED REASONS FOR THE DENIAL OF THE ORIGINAL REQUEST: (Be specific, e.g. why the accommodation would not be effective)

13.YOUR REQUEST WAS ADMINISTRATIVELY CLOSED BECAUSE OF NO RESPONSE FROM YOU TO INQUIRIES MADE ON THE FOLLOWING DATES:

WHEN YOU WISH TO PURSUE THIS REQUEST, PLEASE CONTACT ME AND I WILL RE-OPEN IT

14.YOU WILL HAVE A WEEK FROM THE DATE OF THIS NOTICE TO DECIDE WHETHER TO ACCEPT THE ALTERNATIVE ACCOMMODATION OFFERED. IF YOU DECIDE NOT TO ACCEPT, YOUR OPTIONS ARE LISTED BELOW.

15.IF YOU WISH TO REQUEST RECONSIDERATION OF THIS DECISION, YOU MUST:

Within seven (7) calendar days of receipt of this denial, request reconsideration by the second level Designated Management Official (DMO). After receiving a request for reconsideration, the DMO has 14 calendar days to render a decision and notify the requester, in writing.

16.IF YOU WISH TO FILE AN EEO COMPLAINT, PURSUE A MERIT SYSTEMS PROTECTION BOARD COMPLAINT OR A UNION GRIEVANCE, GUIDANCE IS PROVIDED BELOW:

•To file an EEO complaint, applicants for employment or employees must contact an EEO counselor within forty-five (45) days of notice of the denial, pursuant to 29 C.F.R. Part 1614. Contact your local Office of Resolution Management for further information.

•Non-Bargaining Unit Employees may file an Administrative Grievance within 15 calendar days of receiving the denial. Contact your local Human Resources Office for further information.

•Bargaining Unit Employees may file a grievance in accordance with applicable Collective Bargaining Agreements. Contact you local union representative for further information.

•For a collective bargaining claim, file a written grievance in accordance with the provisions of the Collective Bargaining Agreement; or

•Initiate an appeal to the Merit Systems Protection Board within 30 days of an appealable adverse action as defined in 5 C.F.R. §1201.3.

•Employees and applicants are encouraged to participate in information resolution processes available to address the reasonable accommodation outcome. The ADR process is outlines in VA Directive 5978: Alternative Dispute Resolution. Individuals may participate in ADR as part of the above avenues of redress or independently. If participation in independent of the above avenues of redress, it does not meet the requirements for filing claims under the aforementioned processes. If the employee believe she or he may also want to pursue other avenues of redress, the employee should check with the appropriate EEO/Union/HR office to ensure that time requirements are met. Contact your local ADR Coordinator at http://www1.va.gov/adr/docs/ ADR_Coordinators_List.pdf for further information.

Reconsideration, review, and the use of alternative resources does not affect the time limits for initiating statutory and collective- bargaining claims. Your participating in VA's information alterative dispute resolution process will neither satisfy nor delay time restrictions of the formal processes indicated above.

17. DMO SIGNATURE

19.I (REQUESTOR) CERTIFY THAT I RECEIVED THIS FORM REQUESTOR SIGNATURE

18.DATE

20.DATE

21.I (REQUESTOR) CERTIFY THAT I ACCEPT THE ALTERNATIVE ACCOMMODATION OFFERED (IF ONE IS OFFERED) 22. DATE REQUESTOR SIGNATURE

This form should be retained separately from the employee's Official Personnel Folder.

VA FORM 0857f, MAY 2013, page 2

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This PDF will require specific details to be typed in, so be sure you take the time to fill in what's asked:

1. While completing the accommodation request would form, make sure to complete all of the needed fields in their relevant area. This will help facilitate the work, allowing for your information to be handled promptly and correctly.

va form 0857a conclusion process shown (stage 1)

2. The subsequent part would be to fill in the following fields: ALTHOUGH WE ARE NOT PROVIDING THE, WE BELIEVE THIS ACCOMMODATION, YOUR ORIGINAL REQUEST WAS DENIED, YOU DO NOT HAVE A DISABILITY, THE ACCOMMODATION REQUESTED WOULD, THE ACCOMMODATION WOULD REQUIRE, and THE MEDICAL DOCUMENTATION PROVIDED.

The way to prepare va form 0857a stage 2

3. Completing THE MEDICAL DOCUMENTATION PROVIDED, THE ACCOMMODATION WOULD REQUIRE, THE ACCOMMODATION WOULD CAUSE AN, ALLOWING YOU TO WORK WOULD CREATE, and VA FORM MAY is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Step # 3 of filling in va form 0857a

Always be very mindful when filling in ALLOWING YOU TO WORK WOULD CREATE and VA FORM MAY, as this is where many people make a few mistakes.

4. Completing DETAILED REASONS FOR THE DENIAL, YOUR REQUEST WAS ADMINISTRATIVELY, YOU WILL HAVE A WEEK FROM THE, IF YOU WISH TO REQUEST, Within seven calendar days of, IF YOU WISH TO FILE AN EEO, To file an EEO complaint, notice of the denial pursuant to, and NonBargaining Unit Employees may is crucial in the fourth stage - make sure to spend some time and fill out each blank area!

IF YOU WISH TO FILE AN EEO, YOUR REQUEST WAS ADMINISTRATIVELY, and DETAILED REASONS FOR THE DENIAL inside va form 0857a

5. And finally, the following final segment is what you will need to complete before using the form. The fields in this instance are the next: DMO SIGNATURE, I REQUESTOR CERTIFY THAT I, DATE, DATE, I REQUESTOR CERTIFY THAT I ACCEPT, DATE, This form should be retained, and VA FORM f MAY page.

Guidelines on how to prepare va form 0857a step 5

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