ATTACHMENT_J_MED_ACCOMODATION.pdf

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Attached to
Blanket Purchase Agreements for Infrastructure Consulting Services- TRANSPORTATION AND VERTICAL STRUCTURES Federal contract opportunity
Solicitation number
MCC-15-RFQ-0046
Issued by
Millennium Challenge Corporation

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ATTACHMENT J

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ATTACHMENT: MEDICAL ACCOMODATION PROCEDURES

Medical accommodation – MCC has engaged the services of the U.S. Department of State’s Office of Medical Services (MED/DP) for adjudication on requests for medical accommodations due to disability.

MCC will facilitate this process but will not adjudicate disputes or appeals in connection with these requests. If the Department of State’s policies for reviewing these requests changes, MCC will be responsible for notifying contractors of the change but will not be responsible for providing an alternative for medical accommodation requests.

Detailed Procedures - Travelers requesting medical accommodations based upon disability must complete the steps below.

Traveler completes Form DS4086. When complete the traveler selects the “Submit” button, which will create and attach the document to an e-mail addressed to MED/DP at meddp@state.gov with a copy to the MCC Travel Office at mccmedical@mcc.gov.

Traveler then downloads and provides their physician with Form DS4086A which the physician completes and signs. Once signed, the traveler OR their physician e–mails a scanned .pdf attachment to MED/PD at meddp@state.gov. Alternatively it can be faxed Attn: Domestic Programs 202-663-3673.

MED/DP makes a medical determination based on the information provided by the traveler and the traveler’s physician on the DS 4086A. MED/DP will e-mail the traveler with its decision. If approved, MED/DP will attach a scanned, signed DS-4086. The traveler must e-mail the signed DS-4086 to the travel office at mccmedical@mcc.gov. The DS-4086A, is a State Department document only and should NOT be sent to mccmedical@mcc.gov.

MCC will not approve any business class accommodations beyond normal MCC guidelines unless the traveler has completed the medical accommodation paperwork and received a positive response from MED/DP.

Please note that the process can take several weeks and will depend on how quickly the traveler’s physician faxes the completed DS4068A to MED/DP.

Employee Name: Powers, Jeanette F
Millennium Challenge Corporation: Millennium Challenge Corporation
Name:
Name_2:
Name_3:
Check Box1: Off
Date signed mmddww:
Expiration date mmddww:
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