Form DL1-7071 Request for a Medical Exception or Delay to the COVID-19

Request for a Medical or Religious 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

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File Typeapplication/pdf
File TitleREQUEST FOR A MEDICAL EXCEPTION OR DELAY TO THE COVID-19 VACCINATION REQUIREMENT DL1-7071
SubjectCRC
AuthorU.S. Department of Labor
File Modified2021-11-10
File Created2021-11-10
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