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OMB APPROVAL NO. 14050224Employee Recertification and Ability to Perform in EXPIRES: 01/31/2020
ESTIMATED BURDEN: 30 MINUTES
Emergencies (ESCAPE) Posts
PREDEPLOYMENT PHYSICAL EXAM ACKNOWLEDGEMENT
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How to fill out ds-5507 affidavit of physical
How to fill out DS-5507 affidavit of physical:
01
Start by downloading the DS-5507 form from the official website of the U.S. Department of State.
02
Read the instructions carefully to understand the requirements and purpose of the form.
03
Fill out the personal information section, providing accurate details such as your name, date of birth, and contact information.
04
Proceed to the next section, which requires you to specify the medical condition or physical impairment you are reporting or seeking an exception for.
05
Include all relevant details about your condition, including any diagnoses, treatments, or medications you are currently undergoing or have undergone in the past.
06
If necessary, attach any supporting documents or medical records that can validate your condition or impairment.
07
Complete the section that requires you to disclose any information regarding your employment or educational history related to your medical condition.
08
Provide an explanation of how your condition or impairment may affect your ability to perform certain activities or duties.
09
The form may require you to attest that all the information provided is true and accurate. Sign and date the form accordingly.
10
Review your completed form to ensure all sections have been filled out correctly and any necessary supporting documents are attached.
11
Make a copy of the completed form and any supporting documents for your records.
12
Submit the filled out DS-5507 form and any additional required materials to the relevant authority or organization, as specified in the instructions.
Who needs DS-5507 affidavit of physical?
01
Individuals who are diagnosed with a medical condition or physical impairment that may affect their ability to perform certain activities or duties.
02
Applicants who seek an exception or accommodation based on their medical condition, such as individuals applying for a visa, residency, or employment in certain sectors.
03
Those who are required to disclose their medical history, conditions, or impairments as part of a legal or administrative process, such as during immigration proceedings or disability benefit applications.
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What is ds-5507 affidavit of physical?
The DS-5507 affidavit of physical is a form used to report the results of a medical examination conducted on an individual applying for a United States visa.
Who is required to file ds-5507 affidavit of physical?
Applicants for United States visas are required to file the DS-5507 affidavit of physical.
How to fill out ds-5507 affidavit of physical?
The DS-5507 affidavit of physical must be filled out by a licensed physician who conducted a medical examination on the visa applicant.
What is the purpose of ds-5507 affidavit of physical?
The purpose of the DS-5507 affidavit of physical is to ensure that visa applicants meet the health requirements for entry into the United States.
What information must be reported on ds-5507 affidavit of physical?
The DS-5507 affidavit of physical must include the results of the medical examination, including any conditions or diseases found.
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