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  • Form Approved Budget Bureau No 50 R0073

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Rt A. TO BE COMPLETED BY APPLICANT OR EMPLOYEE (typewrite or print in ink) 1. NAME (last, first, middle) 2. SOCIAL SECURITY ACCOUNT NO. 3. 4. SEX DATE OF BIRTH MALE FEMALE 5. DO YOU HAVE ANY MEDICAL DISCORDER OR PHYSICAL 6. IMPAIRMENT WHICH WOULD INTERFERE IN ANY WAY WITH THE FULL PERFORMANCE OF THE DUTIES SHOWN BELOW? YES I CERTIFY THAT ALL THE INFORMATION GIVEN BY ME IN CONNECTION WITH THIS EXAMINATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. NO (If your answer is YES, exp.

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How to fill out the Form Approved Budget Bureau No 50 R0073 online

Filling out the Form Approved Budget Bureau No 50 R0073 online is essential for conducting medical examinations required by the United States Civil Service. This guide provides a structured approach to completing the form efficiently and accurately.

Follow the steps to fill out the form correctly.

  1. Click ‘Get Form’ button to obtain the form and open it for editing.
  2. In Part A, complete all fields: start with your name, social security account number, sex, and date of birth. Clearly indicate your answers to the medical condition questions, ensuring you provide full details if applicable.
  3. For Part B, the appointing officer must fill in the purpose of examination, position title, and a brief description of job duties. Make sure to circle each functional requirement and environmental factor that is essential to the position.
  4. In Part C, the examining physician will fill in their information after the examination and provide their signature and date.
  5. If applicable, the agency medical officer should complete Part D by providing a recommendation based on the examination findings.
  6. In Part E, the agency personnel officer marks the action taken regarding the applicant’s status. They will enter their name, signature, and date.
  7. Finally, for Part F, circle the appropriate handicap code only if applicable. Once all sections are complete, review the form for accuracy.
  8. Save your changes, then download, print, or share the form as needed. Ensure to send it back in the preaddressed 'Confidential-Medical' envelope.

Complete your documents online today to ensure a smooth and efficient process.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232