Form MCSA-5875 Medical Examination Report (MER) Form

Medical Qualification Requirements

MCSA-5875 2-28-23 508

IC6 - Medical Examiner's Certification Integration Final Rule

OMB: 2126-0006

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2126-0006 can be found here:

2025-01-08 - Extension without change of a currently approved collection

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