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Form: HPFDOS016 Revision #5 Date: 07/10/2015 Jefferson Lab Radiation Control Department Declaration of Pregnancy App. To: HPPDOS014 In accordance with Section 206 of 10 CFR 835, I am voluntarily declaring

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How to fill out withdrawal of pregnancy declaration

01

Find the withdrawal of pregnancy declaration form.

02

Read the instructions on the form carefully.

03

Provide your personal information, such as name, address, and contact details.

04

Specify the date and place where the pregnancy declaration was made.

05

State the reasons for wanting to withdraw the pregnancy declaration.

06

Attach any supporting documents if required.

07

Sign the withdrawal form and date it.

08

Submit the completed withdrawal of pregnancy declaration form to the appropriate authority.

Who needs withdrawal of pregnancy declaration?

01

Anyone who has previously made a pregnancy declaration but wishes to revoke it.

02

Women who have changed their decision to continue with the declared pregnancy.

03

Couples who have undergone counseling and have decided against proceeding with the pregnancy.

04

Individuals who have realized the pregnancy declaration was made by mistake.

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What is withdrawal of pregnancy declaration?

Withdrawal of pregnancy declaration is the process of formally revoking a previously submitted declaration of pregnancy.

Who is required to file withdrawal of pregnancy declaration?

Any individual who previously submitted a declaration of pregnancy and wishes to revoke it must file a withdrawal of pregnancy declaration.

How to fill out withdrawal of pregnancy declaration?

To fill out a withdrawal of pregnancy declaration, individuals must provide their personal information, the date of the previously submitted declaration of pregnancy, and the reason for revoking it.

What is the purpose of withdrawal of pregnancy declaration?

The purpose of withdrawal of pregnancy declaration is to officially revoke a previously submitted declaration of pregnancy.

What information must be reported on withdrawal of pregnancy declaration?

The withdrawal of pregnancy declaration must include personal information, date of the previously submitted declaration of pregnancy, and the reason for revoking it.

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