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Omb form no 3206 0228 at 1995-2026
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- Click ‘Get Form’ to open the OMB Form No. 3206-0228 in the editor.
- Begin with Section A, where you will enter your name, date of birth, and social security number. Ensure all information is accurate.
- In Section B, provide a detailed description of your disease or injury and how it affects your job performance. Be specific about any restrictions.
- Complete Section C by indicating if you have been hospitalized for your condition and provide relevant dates.
- In Section D, list any physicians who will provide statements regarding your condition. Make sure to include their contact information.
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