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LDSS3174 Statewide CH (Rev. 5/05) CENTER/ OFFICE INTERVIEW DATE UNIT ID WORKER ID CASE TYPE 1 CASE NUMBER DISTRICT CASE NAME LIFELINE EFFECTIVE DATE CATEGORY DATE ELIGIBILITY APPROVED BY (SUPERVISOR):

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What is ldss 3174 form to?

The LDSS 3174 form is the Application for Services, which is used to apply for various social services programs.

Who is required to file ldss 3174 form to?

Individuals who wish to apply for social services programs are required to file the LDSS 3174 form.

How to fill out ldss 3174 form to?

To fill out the LDSS 3174 form, you need to provide personal information, income details, household information, and other relevant details as required by the specific program you are applying for.

What is the purpose of ldss 3174 form to?

The purpose of the LDSS 3174 form is to collect necessary information from individuals who are applying for social services programs in order to determine their eligibility for assistance.

What information must be reported on ldss 3174 form to?

The LDSS 3174 form typically requires information such as name, address, contact details, income details, household composition, and any other relevant information required by the specific program being applied for.

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