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2009 H1N1 Influenza Vaccine Screening and Consent Form Section 1: Information about the Patient to Receive Vaccine (please print) PATIENTS NAME (Last) (First) (M.I.) PATIENTS DATE OF BIRTH month day

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What is section 1 information about?

Section 1 information is about providing personal details and demographic information of an individual.

Who is required to file section 1 information about?

All employees are required to fill out section 1 information.

How to fill out section 1 information about?

Employees can fill out section 1 information on Form I-9.

What is the purpose of section 1 information about?

The purpose is to verify the identity and eligibility of employees to work in the United States.

What information must be reported on section 1 information about?

Information such as name, address, date of birth, and citizenship status must be reported.

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