Form Number: HUD-11600

Form Description:

The Disability Program Manager or other decision making official must complete questions 1 through 4 (and, if applicable, question 5), and must sign and date this form.  The original must be forwarded to the employee or applicant that requested the reasonable accommodation and a copy to the Disability Program Manager, if not the decision maker.  The Disability Program Manager shall retain a copy for reporting purposes.