VA Form 0857f at a glance
What it is: Accommodation Request Determination: the purpose of this form is to inform you of the decision regarding your request for accommodation. If the information is incorrect, please inform the DMO as soon as possible.
Who signs: The DMO signs in box 18 and enters the date in box 19. The employee signs box 26 to accept the offered accommodation, or box 28 to not accept the accommodation(s) offered, and enters the date in box 27 or box 29. If the employee decides to submit a reconsideration request, the employee follows the instructions provided in block 16.
A filled-in VA Form 0857f example: a decision making official approves the requested accommodation
How to fill out VA Form 0857f, box by box
Employee or applicant name and title
Enter the name of the employee or applicant making the request in box 1 and the employee official title in box 2 (N/A for applicants).
Decision making official (DMO) name, phone and email
Enter the DMO name in box 4, the DMO phone number in box 5 and the DMO email in box 6.
What the requested accommodation will enable you to do
In box 7, mark what the requested accommodation will enable: apply/interview for a job, perform the essential functions of your position, or access benefits and/or privileges of employment.
In box 8, describe briefly the accommodation requested.
Accommodation(s) decision
In box 9, mark the accommodation(s) decision: approved requested accommodation, approved alternate accommodation, or unable to accommodate in current position (skip to block 13).
In box 10, enter the date on or about which the approved accommodation will begin.
Alternate accommodation
In box 11, describe the alternative accommodation: although the requested accommodation is not provided, an alternate accommodation is offered which is believed would be effective.
In box 12, describe why the alternate accommodation would be effective.
Your original request was not granted because
In box 13, mark why the original request was not granted: the accommodation requested would not be effective; the accommodation would require removal of an essential function(s) of the job; the accommodation would require lowering of a performance or production standard(s); the accommodation would cause an undue hardship to the operation of the facility and/or unit; or allowing you to work would create a direct threat to the safety of yourself or others.
Detailed reason(s) for inability to provide the requested accommodation
In box 14, enter the detailed reason(s) for inability to provide the requested accommodation. Be specific, e.g. why the accommodation would not be effective.
DMO signature
RDMO and RAC name, phone number and email
Enter the RDMO name, phone number and email in boxes 20, 21 and 22, and the RAC name, phone number and email in boxes 23, 24 and 25.
Employee accepts the accommodation offered
In box 26, the employee signs to certify that the employee received this form and accepts the offered accommodation, and enters the date in box 27.
Employee does not accept the accommodation offered
In box 28, the employee signs to certify that the employee does not accept the accommodation(s) offered; if the employee decides to submit a reconsideration request, the employee follows the instructions provided in block 16. Enter the date in box 29.
More rules for VA Form 0857f
If you wish to request reconsideration of this decision, you must ensure you provide a copy of your reconsideration statement to the Reasonable Accommodation Coordinator (RAC) listed in blocks 23 through 25 for record keeping purposes.
After receiving a request for reconsideration, the reconsideration DMO has seven (7) business days to render a decision and notify the requester, in writing via VA0857L, Reconsideration Request Determination form.
If you do not respond to the DMO within the seven (7) business days authorized, your request may be administratively closed.
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 fifteen (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 your 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 thirty (30) days of an appealable adverse action as defined in 5 C.F.R. §1201.3.
Employees and applicants are encouraged to participate in informal resolution processes available to address the reasonable accommodation outcome. The ADR process is outlined in VA Directive 5978: Alternative Dispute Resolution.
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 informal alternative dispute resolution process will neither satisfy nor delay time restrictions of the formal processes.
When sending this form via electronic means, please ensure the file is encrypted to protect the requestors PII & PHI information.
This form should be retained separately from the employee's Official (paper or electronic) Personnel File.
Common questions about VA Form 0857f
Is there a deadline?
You will have seven (7) business days from the date of this notice to decide whether to accept or not accept the accommodation(s) offered.
Sources
[1] VA Form 0857f (AUG 2023), Accommodation Request Determination, Department of Veterans Affairs (served file; no issuer file found) (the Official source link on this page).