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LDSS ADDRESS CITY STATE ZIP CASE NAME New York State Office of Temporary and Disability Assistance LDSS-4836 Rev.4/09 NYSNIP Food Stamp Benefits Interim Report Please fill out this form right away and return it to the address listed above. If you don t send the form back we will have to stop your food stamp benefits. We ve sent this form because we must update your NYSNIP food stamp benefits case. The law says we must do this every two years. Ple.

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