This is the online form to ask for a disability accommodation. If you want to make your request by phone, please call (360) 407-2700 or (800) 583-8271. TTY (hearing impaired) users please dial 7-1-1 or 1-800-833-6388 for the Washington relay operator. A red bar means you must complete the field. NOTE: Please do not use this form to request a hearing. Today's date: Case's Docket Number (if known) What is your name? First Name Last Name Are you requesting accommodation for yourself or for someone else? Myself Someone else If someone else, please state the other person's name and your relationship: The person who needs accommodation is a: Party Witness Attorney/Representative Other If Other, please describe Why do you or the person need accommodation? To participate in a hearing To access a facility Other If something else, please describe: Do you know when you or the person will need the accommodation? Yes No If yes, what date and time? If yes, what date and time?: Date If yes, what date and time?: Time Please explain what kinds of accommodation you or the person need and why: Is there anything else we should know about your request? Your contact information: Email Mailing Address Street Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postal Code Telephone number where we can leave a message: How do you want to communicate with us? Email Mail Phone call Submit Leave this field blank
