Request details
Name of requestor, type(s) of accommodation requested and date of request.
GSA3677
Review of Reasonable Accommodation Request
- Agency
- GSA
- Revision
- Rev. 8/2023
- Fillable fields
- 17
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3677: Review of Reasonable Accommodation Request
GSA Form 3677, Review of Reasonable Accommodation Request, is a U.S. General Services Administration form. Its footer reads GENERAL SERVICES ADMINISTRATION, GSA 3677 (REV. 8/2023), and GSA's page lists HRM 2300.1 as its authority or regulation. GSA hosts it in its forms library.
The form records the decision on a reasonable accommodation request: Approved, Approved with Modification or Denied, each with a date. It is completed and signed by the decision maker, not filed by the requestor. The form says to type or print all applicable entries, attach the decision letter, sign and date, and provide the requestor with a copy of the complete package.
The lower half prints instructions for reconsideration of the decision, including time limits for an EEO complaint and an MSPB appeal. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 3677
Delivery details
A shipping address, if applicable, and a telephone number for delivery.
Decision
Check one of Approved, Approved with Modification or Denied and provide its date, then specify the type(s) of accommodations approved or denied.
Reason for denial
If Denied was checked, one reason is chosen from a list. If the requestor rejected an alternative accommodation, a box asks why the original request was denied and how the alternative would be effective.
Instructions for reconsideration
Printed steps for asking the decision maker to reconsider, asking a higher level manager to review, and filing an EEO complaint, a grievance or an MSPB appeal.
Decision maker signature
Signature of decision maker, name of decision maker and date.
The form is one page with these blocks.
How to complete GSA Form 3677
- 1
Enter the request
Fill in the name of the requestor, the type(s) of accommodation requested and the date of request, plus a shipping address and telephone number for delivery if they apply.
- 2
Check one decision
Check Approved, Approved with Modification or Denied, provide the date, and specify the type(s) of accommodations approved or denied.
- 3
Give the reason for a denial
If Denied was checked, choose one reason from the list. If the requestor rejected an alternative accommodation, explain the denial of the original request and how the alternative would be effective.
- 4
Attach the letter and sign
The form says to attach the decision letter. The decision maker signs, prints a name and dates the bottom block.
- 5
Give the requestor a copy
The form says to provide the requestor with a copy of the complete package.
The form says to type or print all applicable entries. Its date fields ask for a 2 digit month, 2 digit day and 4 digit year.
Why fill Form GSA3677 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Routing and what the form says
Where it goes
The PDF gives no filing address. It says to attach the decision letter and provide the requestor with a copy of the complete package.
Reconsideration
The form says the individual may ask the decision maker to reconsider denial, with additional information to support the request, and may ask a higher level manager to review a supervisor's decision.
Time limits printed on the form
For an EEO complaint under 29 C.F.R. Part 1614, contact GSA's EEO Office within 45 calendar days from the date of the decision. For a MSPB appeal, submit the request within 30 days of an appealable adverse action as defined in 5 C.F.R. Part 1201.3.
Collective bargaining claim
The form says to file a written grievance according to the provisions of the Collective Bargaining Agreement.
Authority
GSA's page lists HRM 2300.1 as the authority or regulation. The PDF prints no OMB number or Privacy Act notice.
Related forms
Who uses GSA Form 3677?
The form names a decision maker who completes and signs it, and a requestor who receives a copy.
Official sources and the blank
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Questions about Form GSA3677
Who issues GSA Form 3677?
The form's footer reads GENERAL SERVICES ADMINISTRATION, GSA 3677 (REV. 8/2023), and GSA's page lists HRM 2300.1 as its authority or regulation. GSA hosts it in its forms library.
Who fills out GSA Form 3677?
The decision maker on the request. The signature, name and date at the bottom are the decision maker's, and the form says to provide the requestor with a copy of the complete package.
What decisions can the form record?
Approved, Approved with Modification or Denied. The form says to check one and provide the date, then specify the type(s) of accommodations approved or denied.
What denial reasons does the form list?
Accommodation ineffective, accommodation would cause undue hardship, medical documentation inadequate, accommodation would require removal of an Essential Function, accommodation would require lowering performance/production standard, requestor rejected an offer of an alternative accommodation, or Other.
What does the form say about reconsideration?
It says the individual can ask the decision maker to reconsider, ask a higher level manager to review a supervisor's decision, and, if the decision is not overturned, file an EEO complaint or pursue MSPB or union grievance procedures.
What time limits does GSA Form 3677 print?
For an EEO complaint, contact GSA's EEO Office within 45 calendar days from the date of the decision. For a MSPB appeal, submit the request within 30 days of an appealable adverse action as defined in 5 C.F.R. Part 1201.3.
What goes with the form?
The form says to attach the decision letter to it, sign and date, and give the requestor a copy of the complete package.