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Request for a Medical Exemption or Delay to the COVID-19 Vaccination Requirement
OMB 0704-0619
OMB.report
DOD/DODDEP
OMB 0704-0619
OMB 0704-0619
Latest Forms, Documents, and Supporting Material
Document
Name
Form DD 3176 Request for a Medical Exemption or Delay to the COVID-19 Vaccination Requirement
Form and Instruction
0704-0619_SSA_4.25.22.docx
Supporting Statement A
Request for a Medical Exemption or Delay to the COVID-19 Vaccination Requirement
Form and Instruction
All Historical Document Collections
202111-0704-010
Extension without change of a currently approved collection
2022-04-27
202110-0704-007
Approved without change
New collection (Request for a new OMB Control Number)
2021-10-19
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