Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020
Why are you being asked to complete this information?
Because we do business with the government, we must reach out to, hire and provide equal opportunity to qualified people
with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if
you ever had a disability. Completing this information is voluntary, but we hope that you will choose to fill it out.
Any answer you give will be kept private and will not be used against you in any way.
Before responding, please read the full Voluntary Self-Identification of Disability form by clicking
here.
*Required information is denoted with an asterisk.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially
limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
- Blindness
- Deafness
- Cancer
- Diabetes
- Epilepsy
- Autism
- Cerebral palsy
- HIV/AIDS
- Schizophrenia
- Muscular dystrophy
- Bipolar disorder
- Major depression
- Multiple sclerosis (MS)
- Missing limbs or partially missing limbs
- Post-traumatic stress disorder (PTSD)
- Obsessive compulsive disorder
- Impairments requiring the use of a wheelchair
- Intellectual disability (previously called mental retardation)
Reasonable Accommodation Notice
Federal Law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us
if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation
include making a change to the application process or work procedures, providing documents in an alternate format, using a
sign language interpreter, or using specialized equipment.
Section 503 of the rehabilitation Act of 1973, as amended. For more information about this question or the equal employment
obligations of the federal contractors, visit the U.S. Department of Labor's office of Federal Contract Compliance Programs
(OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection
of information unless such collection displays a valid OMB number. This survey should take about 5 minutes to complete.