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SELFIDENTIFICTION OF DISABILITY (See Privacy Act information and additional instructions on reverse) Last Name, First Name, and MI Date of Birth (MM/BY)Social Security NumberPurpose: Each agency in
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How to fill out self-identifiction of disability

01
Read the instructions carefully before filling out the self-identification form.
02
Provide accurate personal information such as your name, date of birth, and contact details.
03
Indicate the type of disability you have by selecting the appropriate option from the provided choices.
04
If your disability is not listed, provide details in the 'other' field.
05
Answer all the questions truthfully and to the best of your knowledge.
06
If you need assistance or accommodations during the self-identification process, contact the relevant authority.
07
Submit the completed form according to the given instructions.

Who needs self-identifiction of disability?

01
Individuals who have a disability or think they may have a disability.
02
Employees or job applicants who want to voluntarily disclose their disability to employers or organizations.
03
People who wish to access specific accommodations or resources available for individuals with disabilities.
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Self-identification of disability is the act of individuals identifying themselves as having a disability.
Individuals who have a disability or believe they have a disability are required to file self-identification of disability if requested by an organization or employer.
To fill out self-identification of disability, individuals typically need to provide information about their disability status, type of disability (if comfortable disclosing), and any accommodations they may require.
The purpose of self-identification of disability is to provide organizations and employers with information to support individuals with disabilities in the workplace and ensure compliance with disability rights laws.
Information that may be reported on self-identification of disability includes the individual's disability status and any accommodations needed.
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