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CONSENT/AUTHORIZATION FOR CHILD MEDICAL/CHILD/FAMILY EVALUATION CHILD MEDICAL EVALUATION PROGRAM I. A. Name of Child Date of Birth (First) (Middle) (Last) B. The evaluation is a component of child

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What is dss 5143?

DSS 5143 is a form used by the Department of Social Services (DSS) for reporting certain information regarding income and employment.

Who is required to file dss 5143?

Employers and individuals who have received government assistance or benefits are typically required to file DSS 5143.

How to fill out dss 5143?

DSS 5143 can be filled out online or on paper. It requires providing personal information, such as name and Social Security number, as well as details about income and employment.

What is the purpose of dss 5143?

The purpose of DSS 5143 is to collect and verify income and employment information for individuals receiving government assistance.

What information must be reported on dss 5143?

DSS 5143 requires reporting personal information, such as name, address, and Social Security number, as well as details about income, employment, and government assistance received.

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