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OMB Approved No. 2900-0198 Respondent Burden 10 Minutes Expiration XX/XX/XXXX APPLICATION FOR ANNUAL CLOTHING ALLOWANCE PRIVACY ACT INFORMATION No benefits may be granted unless this form is completed fully as required by law 38 C. AMOUNT OF CLOTHING ALLOWANCES ELIGIBLE 13. EXAMINATION/EVALUATION DATE If applicable 14. NOTES UPPER Extremity LOWER Extremity UPPER/LOWER Extremity 15. Examples include 1 a hand-cycle and a wheelchair utilized by a paraplegic and 2 a running limb and everyday...
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