Amazon RFI form: who fills out each section

What is the Amazon Healthcare Provider RFI form?

RFI stands for Request for Information. Amazon's Accommodations consultant sends it when a request needs medical information. It collects what Amazon uses to evaluate accommodations at work.

The Americans with Disabilities Act (ADA) reaches employers with 15 or more employees. Under EEOC guidance, an employer may ask for medical documentation when the disability or the need for accommodation is not obvious. That documentation can describe the impairment's nature, severity and duration, the activity it limits, and how the accommodation addresses the limitation.

The form's authorization names the ADA and the Pregnant Workers Fairness Act (PWFA). Pregnancy-related restrictions fall under the Pregnant Workers Fairness Act, in effect since 2023. For the general rules on asking for an accommodation, see how a reasonable accommodation request works.

Other Amazon forms, such as the Health Care Provider Form, the Physician Statement and the Return to Work Planning Form, are covered in Amazon's DLS forms explained.

Which RFI did you receive: Operations or Corporate?

Amazon publishes two versions, "Healthcare Provider Request for Information (RFI) Form - Operations" and "Healthcare Provider Request for Information (RFI) Form - Corporate".

Amazon sets which version you receive. Read the title at the top of your own PDF.

Both versions follow the same order: an employee portion first, then a healthcare provider portion. This guide uses the Operations form as the worked example because it is longer, then maps the Corporate sections onto it.

Who fills out each section of the RFI?

You fill out the employee portion, or an authorized representative does. Your healthcare provider or their office fills out the provider portion. On the Operations form that is Sections 1 through 7, marked "Healthcare provider or their office only." On the Corporate form, Sections 1 through 5 are "to be completed by Healthcare Provider or their office only."

Certicare is a telehealth service where leave and accommodation paperwork is completed and signed by a state-licensed provider after an evaluation. There's usually no appointment, and a provider may follow up for more detail before deciding. For the RFI, a state-licensed provider completes and signs the healthcare provider portion where the evaluation supports it, and the employee portion stays with you or your representative.

Completing our intake form starts the review; it does not guarantee a signature, and if the review does not support your request you are refunded in full.

The employee portion

It asks for your name, Amazon alias, date of birth, signature, and the date signed. If a representative signs, it also asks for their relationship to you.

It holds an authorization too. Signing it lets your provider release medical information to Amazon to evaluate "whether and how my medical condition impacts my ability to perform my job duties and to further evaluate accommodations at work."

The provider portion

After the numbered sections comes a signature block. It asks for the provider's name and title, specialty, fax, address, phone, signature, and date of evaluation. The form says: "Please provide your professional stamp with information/signature here or complete the information below."

What does the RFI ask your provider?

Here is what each Operations section asks, under the form's own headings. The answers come from the provider's evaluation.

Section 1 Medical Condition

It opens with a yes/no question: "Does the employee have a disability or medical condition that impacts their ability to perform their job functions?" A diagnosis field follows, with a note that a diagnosis is not required unless the condition is related to pregnancy or childbirth. A second yes/no asks whether the condition is pregnancy- or childbirth-related.

A notice under the Genetic Information Nondiscrimination Act of 2008 (GINA) asks the provider "not to provide any genetic information."

Section 2 Major Life Activities Impacted

Checkboxes list major life activities. The examples on the form include vision, hearing, speech, cognitive/behavioral, social interactions, concentration and learning comprehension, and environmental sensitivity.

Each selection takes a duration or frequency: Constant, Intermittent, Temporary, or Permanent. Two write-in fields follow: "What specific limitations does this employee have in the selected major life activity?" and "How do these limitations affect the employee's ability to perform their job duties?"

Sections 3 to 6: changes to the job

Section 3, Changes to Work Duration/Time/Schedule, covers shift adjustments, reduced time, additional breaks beyond standard breaks, and intermittent absences.

Section 4, Changes to Job Functions, is a set of tables. Lift/carry and push/pull go by weight level. Upper-extremity tasks cover hand grip and overhead, at-shoulder and below-shoulder reach, and body positioning and movement covers bending/twisting, climbing, sitting, squatting, kneeling, standing and walking, with a note on whether the hours listed are continuous or cumulative.

Section 5, Changes to Equipment Operation, lists power equipment, work vehicles, conveyor belts, the handheld scanner, working from heights, and other.

Section 6, Other Changes, lists temperature tolerance, safety equipment/PPE, a medical device, changes to the work environment such as workstation set-up, gloves, elevator, and other.

Under the ADA, an employer does not have to remove an essential function of the job. For a pregnancy-related limitation, the PWFA can allow an essential function to be suspended temporarily. For how restrictions work on site, see restrictions and light duty at Amazon, and for the case where no change fits, see when an employer cannot accommodate restrictions.

Section 7 Accommodation Duration

The options are Temporary, with start and end dates, Permanent, with a start date, and Unknown/Indefinite. The form asks for an anticipated end date. For a duration the provider cannot predict, the form prints its own instruction beside the Unknown/Indefinite option; read it on your copy.

The Corporate form's five sections

Section 1, Medical Condition, matches the Operations Section 1, and the Corporate form notes that "special rules apply to conditions related to pregnancy and childbirth." Section 2, Restrictions and Limitations, and Section 3, Accommodation Suggestion/Other Information, cover the restrictions and the changes to the job that the Operations form spreads across Sections 2 through 6. Section 4, Accommodation Duration, uses "Anticipated Start Date … to End Date" and "Unable to predict end date with reasonable degree of certainty," and Section 5 is the Healthcare Provider Signature and Contact Information.

How do you return the completed RFI?

Both forms give the same instructions. You can upload the completed form to My HR or fax it. If your provider sends it, the form says to fax it. The fax number is printed on the form.

Certicare can also send the completed form directly to Amazon if you ask us to. Turnaround is usually within 24 hours after we have everything needed.

Secure online intake. Your information is reviewed by Certicare and is not sent to Amazon without your authorization.

Under 29 CFR 1630.14(c)(1), medical information from an employer's inquiries "shall be collected and maintained on separate forms and in separate medical files and be treated as a confidential medical record." The Corporate form states: "Amazon will treat this medical information as a confidential medical record consistent with the Americans with Disabilities Act and any other applicable law."

What happens after Amazon receives it?

Amazon reviews the RFI and decides the accommodation. Under EEOC guidance, "The employer may choose among reasonable accommodations as long as the chosen accommodation is effective." What the consultant does next is covered in our guide to requesting an accommodation at Amazon.

Certicare is not affiliated with Amazon. Amazon makes the final decision on leave and accommodation requests.