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IndustryTerm personnel systems / personnel information systems / / MedicalCondition cerebral palsy / muscular dystrophy / ADHD / Complete paralysis / celiac disease / spina bifida / Cancer / HIV / palsy / Kidney dysfunction / Blood diseases / chronic pain / Learning disability / dyslexia / emphysema / sickle cell anemia / Crohn's Disease / dysphasia / Cardiovascular/heart disease / colitis / Diabetes Complete Paralysis / multiple sclerosis / disorder / Total deafness / AIDS / burns / Dwarfism Speech/Language / Epilepsy / Partial paralysis / body Partial Paralysis / Gastrointestinal disorders / hemophilia / irritable bowel Other Impairments syndrome / Hearing impairment / scoliosis / alcoholism / tuberculosis / asthma / stuttering / Morbid obesity / / MedicalTreatment dialysis / / Organization Congress / Form U.S. office of Personnel Management Save Form Page / U.S. office of Personnel Management Page / Federal Government / Personnel Office / office of Personnel Management / / Position personnel officer / Executive / / Technology dialysis / / SocialTag 
SELF-IDENTIFICATION OF DISABILITY (see instructions and Privacy Act information on reverse) Last Name, First Name, and MI Date of Birth (mm/yy) Social Security Number