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  • 6934 - Chewy - AR - Clarification Request Letter

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    Keyon
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    This letter from AbsenceOne to Keyon Lecounte requests additional information to process Lecounte's reasonable accommodation request. It notes that the health care provider needs to complete and return an Accommodation Substantiation Form by July 18th with details about the impairment, impacted activities, accommodation duration, and restrictions. The letter provides options to return the documents by upload, email, or fax and contact information for assistance.

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    This letter from AbsenceOne to Keyon Lecounte requests additional information to process Lecounte's reasonable accommodation request. It notes that the health care provider needs to complete and return an Accommodation Substantiation Form by July 18th with details about the impairment, impacted activities, accommodation duration, and restrictions. The letter provides options to return the documents by upload, email, or fax and contact information for assistance.

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    © All Rights Reserved
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    203 views2 pages

    6934 - Chewy - AR - Clarification Request Letter

    Uploaded by

    Keyon
    This letter from AbsenceOne to Keyon Lecounte requests additional information to process Lecounte's reasonable accommodation request. It notes that the health care provider needs to complete and return an Accommodation Substantiation Form by July 18th with details about the impairment, impacted activities, accommodation duration, and restrictions. The letter provides options to return the documents by upload, email, or fax and contact information for assistance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    AbsenceOne

    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

    We value your privacy. For more on what personal information we may collect,
    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

    Dear Keyon Lecounte:

    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.

     Your Request Number: 4A2306L67WL0001GIAR

    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.

    Choose from three ways to Return Your Documents:


    1. Upload: AbsenceOne.com/Chewy
    2. Email: [email protected]
    3. Fax: (859) 264-4382

    Need Additional Help?


    You can access your claim information 24/7 at AbsenceOne.com/Chewy or by calling AbsenceOne at (844) 992-4399. If
    you have any questions, AbsenceOne representatives are available Monday through Friday between 7:00 a.m. – 7:00
    p.m. Central Time.

    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.

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