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Get and Sign 6110 3  Form 2011

Get and Sign 6110 3 Form 2011

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Risk factors or changes in a member's health status since the completion of the annual Physical Health Assessment (PHA). ROUTINE USES: Disclosures are permitted under 5 U.S.C. 552a(b), Privacy Act of 1974, as amended. DISCLOSURE: Mandatory. Failure to fully disclose the requested information may inhibit the Navy's ability to properly assess your physical activity risk factors and may subject you to administrative actions. NAME: DATE OF YOUR LAST PHA: DATE OF BIRTH: 1. Are you 50 years of age...
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