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Get Dd Form 2807 1 2018-2024

E. Loss of finger or toe DD FORM 2807-1 MAR 2015 d. Tumor growth cyst or cancer DoD exception to SF 93 approved by ICMR August 3 2000. REPORT OF MEDICAL HISTORY This information is for official and medically confidential use only and will not be released to unauthorized persons. OMB No* 0704-0413 OMB approval expires Oct 31 2017 The public reporting burden for this collection of information is estimated to average 10 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information* Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing the burden to the Department of Defense Washington Headquarters Services Executive Services Directorate Directives Division 4800 Mark Center Drive Alexandria VA 22350-3100 0704-0413. Respondents should be aware that notwithstanding any other provision of law no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION* RETURN COMPLETED FORM AS INDICATED ON PAGE 2. PRIVACY ACT STATEMENT AUTHORITY 10 U*S*C. 136 DoD Instruction 6130. 03 and E*O. 9397 as amended SSN. PRINCIPAL PURPOSE S The primary collection of this information is from individuals seeking to join the Armed Forces. The information collected on this form is used to assist DoD physicians in making determinations as to acceptability of applicants for military service and verifies disqualifying medical condition s noted on the prescreening form DD 2807-2. An additional collection of information using this form occurs when a Medical Evaluation Board is convened to determine the medical fitness of a current member and if separation is warranted* Completed forms are covered by recruiting medical evaluation board and official military personnel file SORNs maintained by each of the Services. ROUTINE USE S The Blanket Routine Uses found at http //dpcld. defense. gov/Privacy/SORNsIndex/BlanketRoutineUses. aspx apply to this collection* DISCLOSURE Voluntary. However failure by an applicant to provide the information may result in delay or possible rejection of the individual s application to enter the Armed Forces. An applicant s SSN is used during the recruitment process to keep all records together and when requesting civilian medical records. For an Armed Forces member failure to provide the information may result in the individual being placed in a non-deployable status. The SSN of an Armed Forces member is to ensure the collected information is filed in the proper individual s record. WARNING The information you have given constitutes an official statement. Federal law provides severe penalties up to 5 years confinement or a 10 000 fine or both to anyone making a false statement. If you are selected for enlistment commission or entrance into a commissioning program based on a false statement you can be tried by military courts-martial or meet an administrative board for discharge and could receive a less than honorable discharge that would affect your future.

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