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U.S. Office of Personnel Management
SF 256
Revised July 2010
Previous editions not usable
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
ENTER CODE HERE――――― >
Definition:
An Individual with a disability: A person who (1) has a physical impairment
or mental impairment (psychiatric disability) that substantially limits one or
more of such person's major life activities; (2) has a record of such
impairment; or (3) is regarded as having such an impairment. This definition
is provided by the Rehabilitation Act of 1973, as amended (29 U.S.C. 701 et.
seq.).
Purpose:
Self-identification of disability status is essential for effective data collection
and analysis. The information you provide will be used for statistical
purposes only and will not in any way affect you individually. While self-
identification is voluntary, your cooperation in providing accurate
information is critical.
Part I. Targeted/Severe Disabilities
Hearing
18 - Total deafness in both ears (with or without understandable speech)
Vision
21 - Blind (inability to read ordinary size print, not correctable by glasses,
or no usable vision, beyond light perception)
Missing Extremities
30 - Missing extremities (missing one arm or leg, both hands or arms, both
feet or legs, one hand or arm and one foot or leg, one hand or arm and
both feet or legs, both hands or arms and one foot or leg, or both hands
or arms and both feet or legs)
Partial Paralysis
69 - Partial paralysis (because of a brain, nerve or muscle impairment,
including palsy and cerebral palsy, there is some loss of ability to move
or use a part of the body, including both hands; any part of both arms or
legs; one side of the body, including one arm and one leg; and/or three
or more major body parts)
Complete Paralysis
79 - Because of a brain, nerve or muscle impairment, including palsy and
cerebral palsy, there is a complete loss of ability to move or use a part
of the body, including both hands; one or both arms or legs; the lower
half of the body; one side of the body, including one arm and one leg;
and/or three or more major body parts
Other Impairments
82 - Epilepsy
90 - Severe intellectual disability
91 - Psychiatric disability
92 - Dwarfism
Part II. Other Disabilities
Hearing Conditions
15 - Hearing impairment/hard of hearing
Vision Conditions
22 - Visual impairments (e.g., tunnel or monocular vision or blind in one
eye)
Physical Conditions
26 - Missing extremities (one hand or one foot)
40 - Mobility impairment (e.g., cerebral palsy, multiple sclerosis, muscular
dystrophy, congenital hip defects, etc.)
41 - Spinal abnormalities (e.g., spina bifida, scoliosis)
44 - Non-paralytic orthopedic impairments: chronic pain, stiffness,
weakness in bones or joints, some loss of ability to use part or parts of
the body
51 - HIV Positive/AIDS
52 - Morbid obesity
61 - Partial paralysis of one hand, arm, foot, leg, or any part thereof
70 - Complete paralysis of one hand
80 - Cardiovascular/heart disease with or without restriction or limitation on
activity; a history of heart problems w/complete recovery
83 - Blood diseases (e.g., sickle cell anemia, hemophilia)
84 - Diabetes
86 - Pulmonary or respiratory conditions (e.g., tuberculosis, asthma,
emphysema, etc.)
87 - Kidney dysfunction (e.g., required dialysis)
88 - Cancer (present or past history)
93 - Disfigurement of face, hands, or feet (such as those caused by burns
or gunshot wounds) and noticeable gross facial birthmarks
95 - Gastrointestinal disorders (e.g., Crohn's Disease, irritable bowel
syndrome, colitis, celiac disease, dysphexia, etc.)
98 - History of alcoholism
Speech/Language/Learning Conditions
13 - Speech impairment - includes impairments of articulation (unclear
language sounds), fluency (stuttering), voice (with normal hearing),
dysphasia, or history of laryngectomy
94 - Learning disability - a disorder in one or more of the processes
involved in understanding, perceiving, or using language or concepts
(spoken or written) (e.g., dyslexia, ADD/ADHD)
Other Options
01 - I do not wish to identify my disability status. (Please read the notes on
the next page.) (Note: Your personnel officer may use this code if, in
his or her judgment, you used an incorrect code.)
05 - I do not have a disability.
06 - I have a disability, but it is not listed on this form.
