REASONABLE ACCOMMODATION

Request for a Reasonable Accommodation

If you, or a member of your household, has a disability and would like Allen Metropolitan Housing Authority (AMHA) to consider a change or modification to a policy, rule, practice, procedure, or service so that you (or a family member with a disability) may have an equal opportunity to participate in the Housing Choice Voucher Program, please advise the AMHA of the requested accommodation by utilizing this form or by contacting AMHA.

Please note the following information before completing this form:

Your request for an accommodation will need to be verified by a knowledgeable third-party of your choosing unless the accommodation obviously meets the need of the requestor. This may include a doctor or other medical professional, a peer support group, a non-medical service agency, or reliable third party who is in a position to know about the individual’s disability.
All approved reasonable accommodation will require an inspection within 90 days of lease start date or annual recertification.
Any requests for reasonable modifications (structural changes) and/or requests for service or assistance animals should be directed to the property owner/manager.
Any information you include on this form is a voluntary disclosure. AMHA does not require disclosure of a specific diagnosis nor detailed medical records to approve an accommodation. However, AMHA cannot approve an accommodation request when the relationship (nexus) between the accommodation and the individual’ s disability is not identifiable.

A qualified individual with a disability, for reasonable accommodation purposes, is defined as:

An individual with a physical or mental impairment which substantially limits one or more of the person’s major life activities; or
An individual who has a history of, or is regarded as having a physical or mental impairment that substantially limits one or more major life activities.

Your request must be made by or on behalf of the individual who meets the above-stated definition.

Any request that requires verification by a knowledgeable third-party will need to complete the enclosed Release of Information and Authorization Regarding Medical Information form and Verification of Need for Reasonable Accommodation form along with this form.

Please answer all of the questions below with true and complete information.

Head of Household:

Phone:

Name of household member with the disability:

As a result of my/my household member’s disability, the following change or changes are requested so that we can participate equally and successfully in the Housing Choice Voucher Program (Please check all that apply):

A change in the way we communicate with you

A change in a rule, policy, service, or procedure

Please list the person in need of the accommodation:

If you are requesting a change to a rule, policy, service, or procedure please indicate which rule, policy, service, or procedure on the line below:

Based on my/my family member’s disability, I need this accommodation because or in order to:

What alternative accommodation(s) could meet the same need should the request made be unavailable or deemed unreasonable?

REASONABLE ACCOMMODATION

Request for a Reasonable Accommodation

All approved reasonable accommodation will require an inspection within 90 days of lease start date or annual recertification.

Any requests for reasonable modifications (structural changes) and/or requests for service or assistance animals should be directed to the property owner/manager.

A qualified individual with a disability, for reasonable accommodation purposes, is defined as:

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Your request must be made by or on behalf of the individual who meets the above-stated definition.

​

Any request that requires verification by a knowledgeable third-party will need to complete the enclosed Release of Information and Authorization Regarding Medical Information form and Verification of Need for Reasonable Accommodation form along with this form.

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​Please answer all of the questions below with true and complete information.

Please answer all of the questions below with true and complete information.