Housing Authority of the City of Los Angeles residents and Section 8 participants request disability accommodations, such as policy exceptions, unit modifications or changes to common areas, on Reasonable Accommodation Questionnaire S 504-02. Item 2 names a professional who can verify the disability and the disability-related need. HACLA then contacts that person directly; there is no published clinician form to download.
The head of household or co-head completes and signs the questionnaire, naming the household member, the accommodation needed and the verifier's contact details. The named professional, such as a licensed physician, physical therapist, psychiatrist, social worker, caseworker or counselor, answers HACLA's verification request.
Download the current version from the source each time; forms change without notice.
Reasonable Accommodation Questionnaire (with third-party verification of disability-related need)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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HACLA does not publish one. The tenant names a verifier in item 2 of S 504-02, and HACLA contacts that professional directly to verify the disability and the disability-related need for the accommodation. Respond to the request HACLA sends rather than looking for a downloadable form.
Item 2 lists examples: a licensed physician, physical therapist, psychiatrist, social worker, caseworker or counselor. The list is not exhaustive, so another professional who knows the person's disability and the need for the accommodation can be named, with agency, address, phone, fax and email.