nsa/css policy 4-23: the nsa's disabilities policy

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  • 8/3/2019 NSA/CSS Policy 4-23: The NSA's Disabilities Policy

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    uNCLASSrFIgnmOn Onml

    NATIONAL SECIJRITY AGENCY

    CENTRAL SECT]RITY SERVICBNSA/CSS POLICY 4-23

    Issue Date: 6 Marclil 2006Revised:

    (U) PROVISTON OF REASONABLE ACCOMMODATION

    (u) PURPOSE AND SCOPE-(U) This document establishes policy, describes procedures, and assigns responsibilities

    for the NSA/CSS reasonable accommodatlon process, in accordance with the FederalRehabilitation Act of 1973 (Reference a), the Americans with Disabilities Act, as amended(Reference b) and Executive Order l3 | 64, "Requiring Federal Agencies to Establisl,r Proceduresto Facilitate the Provision of Reasonable Accommodation" (Reference c).

    (U) This policy applies to all civilian and military personnel throrrghout the NSA/CSSglobal enterprise, ineluding those serving a trial period and applicants for ernployrnent.

    JOHN TAFLANAssociate DirectorHuman Resources

    Endorsed by:Di,rector of Policy

    Encls:(U) AnnexA-Procedures(U) Annex B

    -Agency-Wide Mandatory Accessibility Requirernents

    (U) Annex C - Request for Accornrnodation(U) Annex D - Internet Resource List

    fa '{,

    UNCLASSIFINN//FOR OFFTC \

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    UNCLASSIFIEI}/IT'

    Policy 4-23 Dated: 6 March ?,0Q6DISTRIBUTION IPLUS: MC (5 stock copies)

    MC2MA2DC3lDC32t (VR)DC36 (Archives)

    (U) OPI: Disability Affairs, MC2 (963-7079s, 301-688-7779b).(U) The cornpilation ofthe information contained in th.is docur.nent is LJNCLASSIFIED//FOROFFICIAL USE ONLY. No seetion of this doc0n'rer'rt shall be released without approval fromthe Office of Policy and Records (DCa).

    GD POLICY

    l. (U) NSA/CSS shall provide r.oasonable accommodationw qualified tudividwls withdisabilities during all stages of pre-ernploymnt and employment (References a and d).2. (U) NSA/CSS shallprovide access for qualified individuals with d'isabilities to

    NSA/CSS facilities, prcgrams, and electronic and information techrulogl (lT) systems, i'naccordance with the standardsfor accessibilityinSection 508 of Refernce a (AnnexB). Inaddition to the statutory rcquircrnents of Section 508, NSA/CSS shallvoluntarily comply withSection 508 provisions for all other electronic and IT systems, except as exempted for those thatinvolve a compelling national security rnission requirement; those that involve titne+riticalnational security operational requirements and will be used by fewer than 25 people; or thosethat preclude compliance for anonyrmity reasons. If an entity is using an exernption ftorn Section508 cornpliance, the facts and circurnstances must be fully explained in the contracting

    documents.

    3. (U) Copies ofNSA/CSS reasonable accommodation procedrues shallbe madeavailable on the NSAnet, in hardcopy format, and in fonnats readily accessible by ind'ividualswith disabilities.

    4. (U) NSA/CSS is not responsible for providing reasor,rable accommodations toindependent contractors (lCs) except for physical modifications to NSA/CSS facilities (inaccordance with Reference d). The lC's Conracting Offrcer's Technical Representative (COTR)should contact Disability Affairs (MC2) or the Office of Goneral Counsel (D2) for furtherguidance.

    5. (U) NSA/CSS isnot required to lower productivity standards, rcmove or change the

    essential job ftnctioru, or create a position as an accomnnodation for individuals with disabilities(Reference b).

    6. (U) NSA/CSS is not required to provide any accommodation that causes unduchards h ip ( Reference b).

    UNCLASSIFIED//F

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    ---UNCTASSIFIED/

    Palicy 4-23 Datod: 6 March 2006

    (U) RESPONSIBILTTIES

    7. (U) Applican.ts, Employees and Integrces shall:

    a. (U) lnitiate requests for reasonable accommodation eithor personallyor throulh representatives, The gai,ning organization wi'll csordinate with DisabilityAffairs (MC2)to provide the accomrlodation for detailoes.

    b. (U) Cooperate with the accomr,nodation process by providing necessarydsoumentation, including rnedical inforrnation, as needed by NSA/CSS. Failure tocooperate (i.e., failure to provide documentation) eould result in denial ofthe request; and

    c. (U) Respond to an offer of accommodation wl,ten one has been offiered but notrequested.

    8. (U) Supenisors/lVtranagers shall:

    a. (U) Consider and approve rcquests, unless the rcquest should be handled by. Disabitity Affairs (MC2). If accom.rnodation is approved at the supervisory/ rnanageria.l

    level, the decision maker is responsible for detennining what accornrnodations areappropriate and effective;

    b. (U) Mainain confidentiality ofthe request;

    c. (U) Discuss a request with the ernployee no later than two business days frornthe date of the request. If the discussion does not occur within two business days, the

    supervisor/manager will docurnent the reason(s) for the delay;

    d. (U) Discuss the need for an accornmodation with a qualified individual wifidisability, when it is observed that a disability rnay be linniting an employee's ability toperform the job at a fully successful level or when an accornrnodation could irnprove anemployee's job performance or an applicant's ability to participate in the selectionprooess;

    e. (U) Im.rnediately contact Disabitity Affairs (MC2) for assistanee indetermining the appropriate accommodation(s) if an ernployee cites a rnedical conditionas the basiJfor a iong-term inability to perfonn oertain aspects of his/l,rer assigned dutiesor makes a rquest for an accom.rnodation where the disability is not obviotts;

    f. (U) Participate on any Reasonable Accomrnodation Fanel (RAP) convenedregarding one of tteir employees, if requested to do so by Disability Affai,rs (MC2)-

    UNCLASSIFIED//F

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    Dated: 6 March 2006

    g. (U) Forward to Disa,bility Affairs (MC2) docurnentation (Anr..rex E and otherappropriate medical documentation) reflecting all acconarnodation requests and decisionsconcerning the request;

    h. (U) If able to provide the accom'rnodation:' l) (U) Act pronaptly to irnplernent the requested aocornrnodation. If the

    accommodation or the aocommodation deoision is delayed by more tharl 15 daysfrorn the date ofthe request, the supervisor/rnanager will document the reason(s)why; and

    2) (U) Forward a cornpleted copy of the fon'n at Annex E of this policy, toDisability Affairs (MC2), as soon as possible, for record-keeping purposes.

    i. (U) If unable to provide the accomnrodation, refer the request to DisabilityAffairs (MC2) as soon as the decision is rnade that the accomrnodation cannot be .provided.

    9. (U) Disability Affairs (MC2) shall:

    a. (U) Provide aecommodation, if possible;

    b.(U) Ovgrsee the processing of alt requests for accommodation including thoserequested itriougn the Leavi Bank ant Leave Sharing programs' Work-life Services andWorker's Cornpensation prograrns;

    c. (U) Maintain docurnentation and confidentiali'ty ofall accornrnodation rquests

    and accommodation decisions rnade by NSA/CSS personnel for the duration of theemployee's tenure;

    d. (U) Convene a RAF to serve as the deoision-maker on matters that requireinput frorn several AgencY offices;

    - e. (U) Serve as the focal point for questions about reasonable accornmodation andrsourcs avaitable inside or outside NSA/CSS;

    f. (U) Educate managers aRd:superuisors in processing accornrnodation requests;

    g. (U) Facilitate the funding of acoommodations and provide supervisors andrunug.it with information regarding resources and types of acconnmodation;

    h. (U) Work wi.th the Office of Recruifinent and Staffing as neoessary, to deviseeffective accommodation for applicants, if required;

    i. (U) Coordinate with the gaining organization concerning detailees who requestaccommodation; and

    UNCLASSIFIED//FOR O

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    UNCLASSIFIED//FOR O

    Dated: 6 March 2006olicy 4-23

    j. (U) Make copies ofthe reasonable accommodation procedurcs.so that they arereadily available to all NSA/CSS employees.

    10. (U) The Ch'ief Informa,tion Officer (DK) shal.l review and approve or disapproverequests for exemptions fror.n Section 508 eompliance (i.e., cornpelling national security r'nissionrequirements).

    I 1. (U) Occ.upational Health, Environmental and Safety Services (ME) personnelshall:

    a. (U) Review nredical documentation, when requested, and advise DisabilityAffairs (MC2) regarding whether or not the individual has a disability;

    b. (U) Advise MC2 on all requests for medical infonnation and assist witherafting rquests for rnedical information to ensurc that only information relevant to theclairned disability is requested or d.isclosed;

    c. (U) Frovide MC2 or the decision maker with a sumrnary of the medicalinformation atready in Occupational Health, Environmental, and Safety Services (ME)'sfiles, which perta.ins exclusively to the clai.rned disability accornrnodation request, so thatMC2 may determ,ine whether the employee has a covered disability;

    d.(U) Make every reasonable effort to assist employees who do not meet thedefinition of "qualified individual with a disability" to be fully productive, preserve theirhealth, and prevent exacerbation of illnesJinjury and disability;

    e. (U) Farticipate in the deliberations ofthe RAP, as required; andf. (U) Refer requests for accommodation ts the Office o'f Disability Affairs.

    12. (U) Ofiice of the General Counsel @2) shalt:

    a. (U) Provide advice to the decision maker, Disability Affairs (MC2), or anyotherNSA/CSS official with regard to the reasonable accomrnodation process; and

    b. (U) Provide.advice to the R,AP (not to include the approval or d'isapproval ofgrant ing accomrnodations).

    13. (U) Facilities Services (LF)penson'nel shall:

    a. (U) Assist in providing reasonable accommodations, as necessaty, and

    b. (u) Participate in the deliberations of the RAP, as requ'iretl.

    UNCLASSIFIED//FOR onrrlel*l HSE ffi

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    6 March 2006

    14. (U) Ollice of Recruitment end Staffing $MB) shall:

    a. (U) Coord,i'nate appl,icant rqucsts for accomrnodation witt'r Disability Affa'irs(MC2);

    b. (U) Advise applicants of the essential job functions of a position.(Recruitment and Staffing personnol rnay ask the applicant hsw he/sl're will meet therequirements of the job); and

    c. (U) Conduct searches fbr vacancies for curent ernployees with disabilitieswho must be reassigned.

    15. (U) Oflice of Equal Employment Opportunity @6) shall:.

    a. (U) Refer requests for reasonable accornmodation to Disability Affa'irs (MC2)for processing; and

    b. (U) Frocess EEO connplaints regarding denied reasonable acoomrnodationrequests in accordance with Ref,erences e and f.

    (u) REFERENCES

    16. (U) References:

    a. (U) Title 29 United States Code Section 791, "The Federal Rehabilitation Act

    of 1973," as amended.

    b. (U) The Americans with Disabilities Act of 1990.

    c. (U) Executive Order l3l64,"Requiring Fedoral Agencies to EstablishProcedures to Facilitate the Provision of Rsasonable Accommodation," dated July 26,2000.

    d.(u) Title42 united states code, section 415l et. seq., "Ttre Architectr,rralBarriers Act."

    e. (U) PMM Chapter 365, "Equal Employrnent Opportunity."

    f. (U) 29 Code of Federal Regulations, Sections 1614, "Federa,l Sector Equal .Employment Opportunity" and 1630, "Regulations to Implen.lent the Equal EmployrnentProvisions of the Americans witt'l Disabilities Act."

    g. (U) PMM Chapter 352, Section 6'a (lg) "Basic Pay Rates."

    UNCLASSIFIED/IF'OR O

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    UNCLASSIFIEI}//FOR O

    (U) AnNEx A

    (u) PROCEDIIRES

    l. (U) Initiating the Reasona,ble A,ccominoilation Process:

    a" (U) The reasonabte accommodation process begins when a requestfor*"o *ofution (hereafter "requesf) is made by an ermployee or applicant. To begin theprocess, the individual or hiVher representativ must advise an Ageney oficialthat anidjustment or change at work is needed for a rcason related to a rnedical eondition.When a reprcsentative makes a request on behalf of an individual, the Agency officialwilleonfinn with the individua,l that the accornmodation is desired.

    b. (U) The initial request rnay be rnade orally or in writing. Individuals are notrcquired to mention the Rehabilitation Act, the ADA, or the phrase "reasonableaccornmodation" in requesting an aocommodation. Furthermore, an individr'ral with adisability is not requ.ired to rmake a request for a reasonable accommodation at anyparticutar time. The Agenoy official rnay ask for the r,equest in writing for reeord-keeping purposes (Annex E: n'Request for Accomrnodation'), bUt rnay not delay ininitiating the reasonable accornmodation prooess.

    c. (U) Once the accornmodation is approved, the anployee is not requiredto rnake another request. In such situations, the employee may obtain theaccommodation by notice to the appropriate individual or offico, e.g., for sign languageinterprcter services.

    d. (U) Managers generally may not ask an applicant whether he/she needs a

    reasonable accommodation for the job. The hiring rnaRager rnay speciff the essential jobfunctions and ask the applicant how he/she will meet the requirernents of the job.

    e. (U) lf the appticalat has an obvious disability or voluntarily discloses adisability, the manager should contact Disability Affairs (MC2) for guidance, ifnecessary. MC2 personnel will work with the manager and tl're applicant to devise aneffective accommodation strategy.

    2. (U) Prccessing the Request:

    a. (U) Throughout this interactive process, those responsible for accomrnodationdecisions will communicate with the requestors to gain a clear unders0anding of the needs

    involved. The employee requestingthe accommodation should participate to the extent

    'possible in helping toidentiff an effective accornmodation. This will help to ensure thatthe most effective accommodatisn can be provided.

    Annex A to Policy 4-23Dated: 6 March 2006

    UNCTASSIFIED//FOR

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    ONI#

    b.(U) When a disability and/or need for accomrnodation is not obvious, therequest shoutd be referred to Disability Affairs (MC2). MC2 will advise whether medicalinformation is necessary to support the request, whether the medical infonnatiotlprovided by the requestor is insufficient, or if the Agency already has all the necessarymedical infonmation to process tl,re request.

    c. (U) If the supervisor or other individual receives a request wlaere the need forthe accornmodation isobvious, but he/she is unable to impler'nent the request, he/she willref,er the rcquest to Disability Affairs (MC2) for resolution, either to suggest andimplernent an alternate but effective accommodation or to determine if anyaccommodation oan be rnade. Under these circumstances, MC2 will be the firaal decisionmaker. MC2 may use the procedures outlined in this Annex to resolve these issues.

    d. (U) All decisions will be made on acase-by-case basis and all req.uests will bekept confidential.

    e.(U) The manager's response to an employee's request for a medically basedadjustment to his or her ernployment situation may vary depending on the nature of themedical condition. lf an ernployee cites a rnedical condition as the basis for a long-terminability to perform certain aspects of his/l,rer assigned duties, then the rnanager shou"ldimmediately contact MC2 for assistance in deten'nining the appropriateaccommodation(s).

    f. (U) NSA/CSS will begin processing the request within two wor{

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    UNCTASSIFIED/

    i. (U) Where there are extenuating circurnstances, (e.9. delays in the recei,pt of,medical documentation, equ.iprnent is backordered, etc.) the decision rnaker(s) will notiffthe requestor, in writing, of the reason for the delay and keep him/her inforrned of theexpected date that the request will be ptocessed.

    j. (U) The supervisor or other individual receiving the request shall ask for thereq.uest in writing (using the fonn in Annex E) for racord-keepir'rg purposes and sharllforward a copy ofthe docurnont to Disability Affairs (MC2), but may not delayprocessing the request while awaiting a writter'r rqust.

    k. (U) Managers who reeeive or pJocess requests should discuss the request withthe omployee as soon as practicable, but may not question ernployees about their rnedicalhistories or rely on assurnptions about an irnpairrnent to determine if an employee rarayneed an accommodation.

    l. (U) Requestors of reasonable acooinrnodation must provide appropriatemedical information related to the disability and proposed accomnodation where thedisability or need for accorrmodation is not obvious. This includes sufficier,rtinformation for the Agency to detennine if the ernployee or applicant is a qualifiedindividual with a disability under Reference a. The Agency rnay request relevantsupplernental medical infonnation. If the infonnation subrnitted does not clearly explainthe nature of the disability or substantiate the need for reasonable accom'rnodation or ifthe medical information subm'itted is not sufficient, NSA/CSS may also require that aphysician of NSA/CSS's choosing exarnine the requesting individual at the expense ofNSA/CSS.

    m. (U) When necessary, Disability,Affairs (MC2) will consr*it with a health careprofessional in Occupational Health, Environmental and Safety Services (ME) to ensurethat only information relevant to the specified aecomr,nodation is requested.

    n. (U) lfthe information provided by the heal'th car or other appropriateprofessional is insufficient to detemline whether an aocom,modation is appropriate,Disability Affairs (MC2), with guidance from Oceupational, Health, Environmental andSafety Services (ME), may request further relevant medical information. MC2 willexplain in writing to tlre employee seeking the accomrnodation why the infonnationprovided is insufficient, what additional information is needed, and why it is necessaryfor a detennination of the reasonable accomrnodation rquest. Ernployees will be giventhe option to sign a medical release form, so that OHESS medical professionals ntay askquestions of the requestor's health care professional to clariff rnedical information and to

    supplementi

    nadequate docurnentation.

    Annex A to Policy 4-23Dated: 6 March 2006

    A-3

    UNCLASSIT'IED/

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    o. (U) If a disability/accornmodation determination involves a non-obviousdisability, a request for accommodation that impacts upon several Agency offices, orodrer circumstances that Disability Affairs (MC2) deerns appropriate, MC2 rnay convenea tteasonable dccornrnodation Panel (RAP) composed of appropriate representatives.The RAP should be convened within a reasonable time of MC2's r'eceipt of anaccommodation request, not morc than 15 business days, or as soon thereafter as allrelevant inedical and other information is obtained. MC2, considering the RAP's input,will respond in writing to the requestor Ro later than 7 days after the RAF's deliberationsare cornpleted. Because Reference a requires that al.l rnedical infonnation be keptconfidentialo any medical information obtained in conneetion wittl a rquest will be keptin files sparate from the requestor's personnel file, and will be shared only withindividuals who have an ofricial need-to-kttow.

    p. (U) If the rcquestor refuses to aceept the accommodation offered, the Agencymay determine if the ernployee is or is not qualified to remain in the job. If theaccommodation is necessary to Eliminate a direct threat to hiVher health or well-being orthat of fellow employees, or is needed to perfonn the essential functions ofthe position,NSA/CSS may ref,er the matter to Ernployee Relations.

    3. (U) Denial of a Request: When a decision rnaker denies a request sr offers analternative accommodation, the deoision must be provided to the employee in writing andfonvarded to Disability Affairs (MC2). Requests may be denied underthe followingcircumstances:

    a. (U) The decision is rnade that the requestor is not a qualified individual with adisability under Reference a.

    b. (U) The decision maker determines that the requested accommodation wouldcause an undue hardship for NSA/CSS. The decision maker must cooldinate anydecision of undue hardship with Disabil.ity Affairs (MC2) prior to making thisdetermination. Determinations of undue hardship rnust be based on an individualizedassessment of the ernployee's current circurnstances that show a specific accommodatiollwould cause significant detay or expense. A finding of undue hardsh.ip shall be based onthe following:

    l) (U) The natilre and cost of the accornrnodation needed;

    2) (U) The financial rcsources ofthe Agency as a whole;

    3) (U)The impact of the accommodation on the Agency; and/or

    4) (U) The fact that provision sf the accommodation would be undulydisruptive to other employees' ability to work.

    Annex A to PolicY 4-23Dated: 6 March 2006

    A4UNCLASSIFTED//FOR OFI|ICW

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    c. (U) If Disability Affains (MC2) or aRy other Agency official denies anernployee's request for accomrnodation, the ernployee wi:ll be advised in writing of thespecific reasons for the denial, of hiVher right to file an Equal Ernployrnent Opportunity(EEO) eornplaint (Reference e) wittrin 45.days ofthe discriminatory event ("go EEO")and/or use ofthe dispute resolution process for reconsidtfration of the denial ("goresol,ution")

    4. (U) Reassignment Reassignment is an accornrnodation of last resoft. Qualifiedindividuals with disabilities who canRot be accomrRodated in their current position will beconsidered for reassignment to a vacant position as an acconrlrnodation, as follows:

    a. (U) Disabit:ity Af-fairs (MC2) will rneet with the ernptoyee in need ofreassignnnent to deter.rnine skills and background of the individual and request an up-to-date resurne.

    b. (U) Disability Affa,irs (MC2) will noti'fy the Staffing Divisisn (MBl), via e-rnail, of the need for reassignrnent and provide a copy ofthe individual's r'surne.

    c. (U) The Staffrng Division (Mtsl) will review all vacant positions at NSA/CSS,as well as those that are expected to become vacant witl,rin l0 days and that managernentplans to fill, to find a position the individual is qualified to fill. The search will first focuson positions that are equivalent to tt're employee's current position in terms of grade orpay schedule, work role, and skill comrnunity. Ifthere is no vacant equivalent position,the Staffing Division (MBl) will identifo positions in a different work role, pay schedule,or skill community at the onnployee's current grade level. Ifthere is ns vacant position atthe employee's current grade, the Staffir'rg Division (MBl) will search for vacancies at alower grade for which the individual is qualified.

    d. (U) The Staffing Division (MBl) will notif, Disability Afftirs (MC2), via e-mail, within three working days of the request of any available Agency position(s) thatmatch(es) the ernployee's qual ifi cations.

    e. (U) Disability Affairs (MC2) will rneet with the POC for the position(s) toexplain the Reasonable Accommodation Policy and the reassigninent process. The POCwill be advised that the Agoncy will be placing a I'lold on the position with the possibi'lityof directing an ernployee into that position as an accommodation.

    f. (U) If more than one vacancy is identified for wh'ich tlre individual is qualified,the individual will iraterview the prospective offices to determine tt're position to which'he/she would like to be reassigned.

    g. (U) Any employee assigned to a lower graded position as an accommodationwill be entitled to grade and pay retentiqn in accordance with Reference g.

    Annex A to Policy 4'23Datedi 6 March 2006

    UNCLASSIFIE,DIIFOR O

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    h. (U) An employee in a probationary status is eligible for reassigr'lment providedthat helshe was able to perfonn the essential firnctions of hiVher position with or withoutreasonable accomrnodation before the need for reassigrararent arose.

    i. (U) No employee will be required to cornpete for a reassignrnent as anaccommodation. The employee need not be the best qua.lified for the position; he/shoneeds only to have the requisite qualifications for the position as evidenced by comparinghis/her resume against the vacancy announcement, work role.description, skillcommunity requirements, and job description.

    j. (U) If the employee chooses to accept a positior,r outside the loca.l eornmutingarea, Disability Affairs (MC2) shall forward the reassignment action to Global PCSservices for a determination as to whether the Agency will pay the employee's relocationeosts.

    k. (U) If the employee refuses to accept the position identified, he/she will besubject to procssses administered by Employee Relations, including involuntaryseparation in acoordance with Reference h.

    l. (U) Supervisor haining on the Reasonable Accor.nmodation Process is availablethrough the National Cryptologic School.

    Annex A to Policy 4-23Dated: 6 March 2A06

    A-6

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    (rr) Ar\rNEx B

    (u) NsA/css-wxDE MANDATORY ACCESSIBTLTTY REQUXREMENTS

    l. (U) .A,ll NSA/CSS owned or oceupiedlleased buildings r,r.rust coneply with theaccessibility provisions of Seotion 508 of the Federal Rehabilitation Aot as ar'nended. Anycontracts established for the use of extemal facilities (for example, hotels f,or conf,erences ortraining) must reflect the obligation that the facilities be accessible to people with disabilities.

    2. (U) Pursuant to Section 508, elechonie and infonnation technology developed,- proeured, rnaintained, or used by NSA/CSS or an NSA/CSS contactor to perforrn routineadministrative and business applications must comply with regulatory accessibility requirernentsfor individua,ls with disabilities.

    3. (U) Regardless of fonarat, all unclassified vidoo and rlrultirnedia productions -including videcitapes, televised live broadcasts of intemalNSA/CSS television feeds, andrebroadcasts of live telwision feeds - that cona.in speech or sther audio necessary tounderstand the content shall be captioned or taped simultaneously with a qualified si.gn-language interpreter or provided in an alternate format (i.e., transcript).

    4. (LttTFOttO) Offices that rrreed to convert non-captioned videotapes to open or closedcaption may contact Disability Affairs (MC2) for referral. Requests for interpreter services maybe submitted to Disability Affairs (MC2) Interprcting Staff, via e-rnail (DL TER.PS@nsa) orTTY/telephone at 301 -688-7636(b/963-7052(s).

    Annex B to Policy 4-23Dated: 6 March 2006

    B-lUNCLA S SIF'IED//F OR OFFTW

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    UNCLASSIFIEDIMOR OTTII*L USE OffiY

    (u) ANNEX c

    (tr) REQUEST FOR ACCOMT|,IODATION

    (Please print all entries clearly; classifu appropriately)

    l. Narne ofApplicant or Ernployee Requesting Accommodation:

    2. Today's Date:

    3. Date of Request:

    4. Appl i cant' s/Emp loyee' s Contact Informat ion :

    Secure Phone: Non-Secur Phone:Agency ernail address (for employee):Internet email address (for applicant, if available):Applicant's phone number:

    5. Employee's Organization, Building, Roorn Number, Suite Nunaber and Supervisor(with emai t/phone contact inforrnati on) :

    6. Reason for Request, Other Cornments (attach other sheets as necessary):

    7. Accommodation Requested: (Be as specific as possible, e.g., adaptive e,quiprrr.rent,.interpreter,etc.)

    8. Employee/ Applicant's Signature:

    Annex C to Policy 4-23Dated: 6 March 2006

    c-lUNCLASSIF'IED/IFOR OFFTEI^L USE ONI

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    UNCLASSIFIED//FOR

    Agency's Official's Printed Name, Signature ar'rd Date (Con.finning the request):

    Printed Name: Signature: Date:

    9. Disability Determination (For Disability Affairs (MC2) use only):Yes No Determination not made

    10, Accom'modation Determination (Attach other sheets as necessary):(Circle One): Approved Den'ied

    I l. Date Request lrnplernented:

    I2. Follow-up dtre within 30 days of implementation: Date Completed:

    Distribution:

    EmployeeSupervisorMC2

    Annex C to Policy 4-23Dated: 6 March 2006

    UNCLASSIFIED//FOR O

  • 8/3/2019 NSA/CSS Policy 4-23: The NSA's Disabilities Policy

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    Dfrf,fD: 3?ilfr433 REF In: S-3fifiEffifiil

    IINCTASSIF'IEDIm'OR OFFICT " USE ffi

    (u) ANr\rExI)

    (u) TNTERNET RESOTJRCE [rST

    l. (U) Job'Accommodation Network (JAl-t):

    w ww. j an WF!*icd i . wv u .ed u

    2: (U) ;ruterfEleotnrnics Accornrnodation Fnograrn (CAP):

    www.tdcalr.osd . nl il/cap

    3. (U) EEOC Rcasonable Accsmmodation Guidance:

    gnilw.eeoq.eov/policy/d,p-"cg/accommod4tion.htrnl

    Annex D to Polioy 4-23Dmed: 6 March 2006

    D-lTINCT,ASSIF'IED//F'OR OT'F'I

    -