Hiring Center Medical Records Privacy Release (Form 3400)

OMB 1651-0144

Latest Forms, Documents, and Supporting Material

Document Name
Form 3400 Medical Records Privacy Act Release Form Form and Instruction
SS 1651-0NEW CBP Hiring Center Medical Records Privacy Act Release Form.docx Supporting Statement A
5 CFR 339.305 (up to date as of 8-18-2022).pdf Supplementary Document
30FRN 1651-0NEW Medical Records Privact Act Release Form.pdf Supplementary Document
5 CFR 339.301 (up to date as of 8-18-2022).pdf Supplementary Document
SORN-OPM-GOV5.pdf Supplementary Document
DHS-CBP-PIA-032a.pdf Supplementary Document
60-day FRN 1651-0NEW.pdf Supplementary Document
Medical Records Privacy Act Release Form Form and Instruction