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U.S. SSA Form ssa-ssa-787 SOCIAL SECURITY ADMINISTRATION Form Approved OMB No.0960-0024 TOE 250 PHYSICIAN S/MEDICAL OFFICER S STATEMENT OF PATIENT S CAPABILITY TO MANAGE BENEFITS In replying use this address PAPERWORK REDUCTION ACT This information collection meets the clearance requirements of 44 U.S.C. PLEASE COMPLETE THE INFORMATION ON THE REVERSE OF THIS FORM Form SSA-787 11-2002 EF 11-2002 Destroy Prior Editions 1.

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