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IMPORTANT: You MUST provide a properly completed application and the required evidence before we can process your application. This form must be filed no later than: Date: 9.Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an. Complete the form, STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE (page 2). All items on this form requiring an answer must be answered or marked "Unknown. " NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON. This form is used to verify the number of identical-weight pieces in bulk domestic mailings. Do not write anything on the original documents. Keep your phone number, email, and mailing address up to date in your account. Depending on your benefit type you may need to call us to complete this task.