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Get Wa Dshs 14-076 2010

Fice. If you have any questions, or if you need a postage paid envelope to return this form by mail, contact your local office. SOCIAL SECURITY NUMBER DATE FOR OFFICE USE ONLY CHANGE REPORTED BY TELEPHONE ON (LIST DATE) WORKER’S NAME Your Responsibilities: If your household gets cash assistance, medical assistance, or Basic Food, you must report changes as described under WAC 388-418-0005 based on the benefits you receive. You must tell us about these changes by the 10th day of the month af.

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