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Form DS-1622 Medical History and Examination for Children Age 11 and
Medical History and Examination
DS-1622
Medical History and Examination
OMB: 1405-0068
OMB.report
STATE/AFA
OMB 1405-0068
ICR 202307-1405-001
IC 14884
Form DS-1622 Medical History and Examination for Children Age 11 and
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1405-0068 can be found here:
2023-12-17 - No material or nonsubstantive change to a currently approved collection
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