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Appendix B: COVID-19 Vaccination Medical Exemption Request Form Request for Medical Exemption for COVID-19 Vaccination Pursuant to Executive Order No. 13G, Covered State Agencies, School Boards, or
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Fill in your personal information including your name, contact details, and organization name.
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Provide the details of the requested item or service in the designated fields.
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Specify the quantity, unit price, and total price for each item requested.
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Indicate the delivery location and deadline for the request.
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GSA 19M - request is typically required by government agencies or organizations that are procuring goods or services through the General Services Administration (GSA).
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It is used to submit a formal request for procurement to the GSA and helps to streamline the purchasing process for government entities.
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Individuals or organizations who have the authority to make purchases on behalf of a government agency may need to fill out this form.
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GSA 19M - Request is a form used to request the approval or modification of a specific service or activity under the General Services Administration.
Individuals or organizations that seek approval for certain services or changes regulated by the GSA are required to file the GSA 19M - Request.
To fill out the GSA 19M - Request, one must provide detailed information about the service or change, including relevant details, supporting documentation, and signatures, as required on the form.
The purpose of the GSA 19M - Request is to formally document requests for approval or modification of services within the GSA framework.
Information that must be reported on the GSA 19M - Request includes identification details of the requester, description of the service or modification, justifications, and any pertinent supporting materials.
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