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Omb no 1625 040 Form: What You Should Know

These documents are also used to administer a DD Form 214T. The application for a medical certificate or a medical certificate amendment is made by providing an application to an MMC-approved doctor.  1. Complete the application forms for a Medical Certificate. Applicants may obtain a copy of the certificate by contacting: 2. The following information should be included in the application: (a) Physical Examination Report(s), (b) Evidence of an appropriate standard of care, and (c) Certification of the applicant's qualification as a person with a disability under the Americans With Disabilities Act (ADA). Applicants can either apply with the Department of Transportation's “ADA” form; or they can complete their own medical certification form; and (d) Evidence of a sufficient basis for the applicant to apply for a medical certificate.  (e) Applicants who have not reached age 21 and who are currently in employment or on active duty under the Uniform Code of Military Justice are exempt from having proof of health and mental fitness verified. They must provide their Social Security Number, name and date of birth, and any certification that they have completed training in basic training, the Air Force Academy or the Defense Intelligence Reserve. An MMC doctor can authorize the issuance of a certificate.  3. In the application for a Medical Certificate or Medical Certificate Amendment, a DD Form 214T must be completed and signed by an MMC-approved doctor, using the application form, before an MMC-approved (DD Form 214) physician can issue a DD Form 214T to the applicant, or a DD Form 214T to an applicant authorized by the applicant's employer. If the physician has not seen a DD Form 214T, the DD Form 214T must be forwarded to the DD Form 214T physician (in which the DD Form 214T is filed) by the MMC-approved physician within 30 days of the date on the certified application form for a Medical Certificate or Medical Certificate Amendment.  4. Medical certificates issued by the MMC are for three years. The DD Form 214T renewal form is also available from an MMC doctor or from an MMC-approved doctor. NOTE: An MMC will not issue a Medical Certificate or Medical Certificate Amendment for the issuance of a Special Issuance Medical Certificate or Special Issuance Medical Certificate Amendment, or an MMC will not issue a DD Form 214T for the issuance of a Special Issuance DD Form 214T.

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