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The NYCHA 015 208 form serves a critical role in ensuring that individuals with disabilities receive the support they need to thrive in their roles within the New York City Housing Authority. This form is designed for both job applicants and current employees who are seeking reasonable accommodations to perform their job functions effectively or to enjoy equal benefits during the employment process. It outlines the necessary steps for individuals to request accommodations, ensuring that they can communicate their needs clearly and efficiently. Key sections of the form include personal details, the specific accommodations requested, and relevant information about the applicant's job position or current employment status. Supervisors and HR personnel are also involved in the process, completing sections of the form to ensure that all requests are handled appropriately. The form emphasizes the importance of confidentiality and requires that completed forms be stored securely while also providing a clear pathway for appeals in case a request is denied. Through this structured approach, NYCHA aims to foster an inclusive work environment that accommodates the diverse needs of its workforce.
Preview - Nycha 015 208 Form
NYCHA 015.208 (REV. 9/04) & REVERSE
Reasonable Accommodation Request
NEW YORK CITY HOUSING AUTHORITY
Human Resources Department
Date Received:
(To be completed by ERAC)
The New York City Housing Authority (NYCHA) will make reasonable accommodations for qualified job applicants and employees with disabilities to enable them to perform the essential functions of their jobs, or to enjoy the equal benefits and privileges of employment and the employment process, unless providing such an accommodation would be unduly costly, extensive, substantial or disruptive, or would fundamentally alter the nature of operation of the Housing Authority or any of its programs. This form shall be made available to, and used by, all job applicants and employees requesting a reasonable accommodation in accordance with NYCHA’s
Reasonable Accommodation Policy and Procedure for Employees and Job Applicants.
INSTRUCTIONS: Where necessary or requested, NYCHA supervisory staff, the Human Resources Placement and Certification Coordinator (Interviewer), and/or the Employee Reasonable Accommodation Coordinator (ERAC) shall assist applicants or employees in completing this form.
Job applicants - Complete Sections I and II and submit this form to the staff supervising the application process. Current NYCHA employees - Complete Sections I and III and submit this form to your immediate supervisor. Interviewers/Supervisors - Complete Section IV, and return one copy of the completed form to the job applicant or employee requesting the accommodation. In a separate confidential file, retain a copy of completed form, and send a copy to the ERAC (Human Resources Department, 90 Church Street, 5th Floor, New York, NY 10007). The original form is to be sent to the
Department Director/HR Director - Complete Section V, as appropriate.
Section I
Both job applicants and current employees should complete this section.
Name
Address
Phone
Accommodation Requested (attach additional sheets and any supporting medical documentation, as appropriate)
Section II
To be completed by job applicants only.
Position/title applied for gvbhfghgfh
Department/Development (if known)
Job Vacancy Notice Number (if known)
Date of Examination/Interview
OVER
NYCHA 015.208 (REV. 9/04) - REVERSE
Section III
To be completed by NYCHA employees only (even if you are currently on leave).
Position/Title
Department/Development
Supervisor
Section IV
This section should be completed by the Interviewer of the job applicant, or by the supervisor of the em- ployee requesting a reasonable accommodation.
Name and Title
Department/Development
Phone
Date Request Received
Signature
Section V
In the event a reasonable accommodation is granted at the outset of the process, this section should also be completed before sending a copy to the ERAC.
If the request involves a personnel action that requires the Human Resources Director’s approval, describe the recommended reasonable accommodation and check RECOMMENDED.
Disposition of the Request for Reasonable Accommodation:
GRANTED
RECOMMENDED
DENIED Date
If a reasonable accommodation has been GRANTED / RECOMMENDED, describe the accommodation:
Name and Title
Department
Signature |
|
Date |
An employee may file a written appeal of the Department Director’s decision with the ERAC
within 10 days of receipt of the decision.
Form Characteristics
| Fact Name | Fact Description |
|---|---|
| Form Title | The form is titled "NYCHA 015.208 (REV. 9/04) - Reasonable Accommodation Request". |
| Governing Body | This form is governed by the New York City Housing Authority (NYCHA) policies. |
| Purpose | It is used to request reasonable accommodations for job applicants and employees with disabilities. |
| Eligibility | Both job applicants and current employees can use this form to request accommodations. |
| Submission Process | Job applicants must submit the form to their supervising staff, while current employees submit it to their immediate supervisor. |
| Confidentiality | A copy of the completed form is kept confidential and stored separately by the supervisor. |
| Decision Timeline | Employees can appeal a decision made by the Department Director within 10 days. |
| Supporting Documentation | Applicants and employees are encouraged to attach any relevant medical documentation when submitting the form. |
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