Form DD 3176 DD 3176 Request for a Medical Exemption or Delay to the COVID-19

Request for a Medical Exemption or Delay to the COVID-19 Vaccination Requirement

DD3176 DRAFT 20211019 (1)

Request for a Medical Exemption or Delay to the COVID-19 Vaccination Requirement

OMB: 0704-0619

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File Typeapplication/pdf
File TitleDD Form 3176, "REQUEST FOR A MEDICAL EXEMPTION OR DELAY TO THE COVID-19 VACCINATION REQUIREMENT"
AuthorDoD Component
File Modified2021-10-19
File Created2021-10-18

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