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Authorization for Release of Medical Information
ICR 200309-1215-003
OMB: 1215-0057
Federal Form Document
OMB.report
DOL/ESA
OMB 1215-0057
ICR 200309-1215-003
( )
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1215-0057 can be found here:
2009-08-24 - Extension without change of a currently approved collection
2006-08-18 - Extension without change of a currently approved collection