June 1, 2026 [recipient name] [recipient address] Re: Request for Reasonable Accommodation — Americans with Disabilities Act Dear [recipient name]: Pursuant to Title I/III of the Americans with Disabilities Act, 42 U.S.C. § 12101 et seq., I am formally requesting the following reasonable accommodation: [accommodation] Facts / supporting context: [facts] Requested resolution: [desired outcome] I request that we engage in the interactive process required by the ADA. Please respond in writing within fourteen (14) days with either an agreement to provide this accommodation, a proposed alternative, or a written explanation of any claimed undue hardship. Sincerely, [user full name] [user address]
ADA Title II · State or Local Government Services
Need to request a modified or reduced schedule adjustment for a health condition?
Generate a formal Accommodation Notice to initiate the official interactive process.
You do not have to struggle in an environment that doesn't accommodate your documented medical needs. Federal compliance frameworks protect your right to reasonable adjustments. Use our informational utility to generate a professional Accommodation Request — such as a flexible start time, modified shift, or temporary reduced hours to accommodate medical appointments or treatment — that clearly outlines your requirements to the responsible decision-maker.
Your rights: the ADA Title II framework
Governing statute
Title II of the Americans with Disabilities Act (42 U.S.C. § 12132)
State and local government agencies must provide reasonable modifications to policies, practices, and procedures to avoid discrimination on the basis of disability.
Mandatory interactive process
Title II covers all programs and activities of state and local governments — a formal request triggers the agency's ADA Coordinator obligations.
Protected status
Formally documenting your request establishes an official timeline, protecting your standing and preventing your request from being filed away or ignored.
What you're requesting
A modified or reduced schedule accommodation, such as a flexible start time, modified shift, or temporary reduced hours to accommodate medical appointments or treatment.
Documentation to gather
Document your treatment schedule, gather a provider letter recommending the schedule modification, and identify how essential job functions can still be performed under the modified schedule.
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Government
ADA Accommodation Request
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The person, company, or agency this letter is addressed to.
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Other accommodations for state or local government services
- Remote Work / Telework Flexibility — State or Local Government Services
- Assistive Technology — State or Local Government Services
- Workstation Modification — State or Local Government Services
- Leave as an Accommodation — State or Local Government Services