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 remote work / telework flexibility 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 full or partial remote work to manage a documented medical condition that is exacerbated by commuting or office exposure — 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 remote work / telework flexibility accommodation, such as full or partial remote work to manage a documented medical condition that is exacerbated by commuting or office exposure.
Documentation to gather
Gather a brief letter from your treating provider describing functional limitations (not diagnosis), document any prior successful remote work periods, and identify the essential job functions that can be performed remotely.
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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
- Modified or Reduced Schedule — 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