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Of Birth and Social Security Number SSN and Name must be completed as they are displayed on the Social Security card. Any variations will cause a No Match result. The date of birth must be on record with the Social Security Administration to be verified. 2. The consent form is valid for only 90 days from the date signed, unless indicated otherwise by the individual named above. Please complete this field if you wish to change this timeframe. 3. Complete the Signature and Date Signed fields 4. C.

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