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G-845 Supplement, Document Verification Request Supplement

G-845 Supplement, Document Verification Request Supplement

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Purpose of Form

This form reflects information that may be relevant to eligibility for Federal, State, and local public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 104-193.

Special Instructions

This form should not be used alone, but only in conjunction with Form G-845 to request verification.

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Form G-845 Supplement, Document Verification Request Supplement

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