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

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1225-0092 can be found here:

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File Type	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