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Dd form 3176-2026
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- Click ‘Get Form’ to open the dd form 3176 in the editor.
- Begin with Part 1, where you will enter your personal information. Fill in your name, DoD ID number, office symbol, date of request, position/title, supervisor's name, and phone number.
- In blocks 8-10, provide detailed descriptions of your medical condition and explain why it prevents vaccination. Use the narrative space effectively to ensure clarity.
- If additional space is needed for your responses, utilize the continuation block (Block 11) by annotating the section and line number.
- Complete Part 2 by having a licensed health care provider fill out their section. Ensure they provide necessary medical certifications and sign the form.
- Review all entries for accuracy before submitting. Signing this form confirms that all information is true to the best of your knowledge.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2021 | 4.8 Satisfied (81 Votes) |
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Related links
Nov 7, 2021 use of the DD Form 3176 and DD Form 3T77 is optional for DoD civilian employees, when DoD civilian employees make a request, they mustRead more
This report was prepared under contract to the Department of Defense Strategic. Environmental Research and Development Program (SERDP).Read more
Failure to provide the information requested on this form may impact DoDs ability to evaluate or act upon a request for a medical exemption from the COVID-19Read more