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Form DL1-7071 Request for a Medical Exception or Delay to the COVID-19
Request for a Medical Exception or Delay to the COVID-19 Vaccination Requirement
Request for a Medical Exception or Delay to the COVID-19 Vaccination Requirement Form
Request for a Medical Exception to the COVID-19 Vaccination Requirement
OMB: 1225-0092
OMB.report
DOL/DM
OMB 1225-0092
ICR 202111-1225-001
IC 250283
Form DL1-7071 Request for a Medical Exception or Delay to the COVID-19
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1225-0092 can be found here:
2022-05-26 - Revision of a currently approved collection
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application/pdf
File Title
REQUEST FOR A MEDICAL EXCEPTION OR DELAY TO THE COVID-19 VACCINATION REQUIREMENT DL1-7071
Subject
CRC
Author
U.S. Department of Labor
File Modified
2021-11-10
File Created
2021-11-10
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