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6934 - Chewy - AR - Clarification Request Letter
6934 - Chewy - AR - Clarification Request Letter
PO Box 144434
Lexington, KY 40512 Phone: (844) 992-4399
Fax: (859) 264-4382
July 6, 2023
Keyon Lecounte
206 Gannett Street
Harrisburg, PA 17112
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how we may use this information and other important areas relating to your
privacy and data protection, please read our privacy notice www.sedgwick.com.
CLARIFICATION NEEDED
Phone: (844) 992-4399 | Web: AbsenceOne.com/Chewy | Fax: (859) 264-4382 | PO Box 14434, Lexington, KY 40512
July 6, 2023
Chewy partners with AbsenceOne to administer Leaves of Absence, and Disability Benefits and Accommodations.
We received information from your health care provider regarding your reasonable accommodation request. However,
we need additional and/or clarifying information as outlined below. This information is due by July 18, 2023.
Clarification Required
Please work with your health care provider to complete the Accommodation Substantiation Form that was sent
to you on 06/20/2023. Be sure to include the impairment that is causing the need for accommodations, the
major life activities that are impacted, the duration of the accommodation, and all specific restrictions &
limitations, if applicable.
Comments
Your provider must update the form, initial and date any changes, and then return no later than July 18, 2023. Failure to
provide the requested information on time may impact your reasonable accommodation request.
Scan this QR code with your smartphone camera to go straight to the AbsenceOne Portal!
Thank you,
Kristin Y.
AbsenceOne
Chewy is committed to providing reasonable accommodations pursuant to applicable law (including, but not limited to,
the Americans with Disabilities Act, the Pregnant Workers Fairness Act, and Section 503 of the Rehabilitation Act of
1973) to help employees perform their essential job functions.