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Four County SSA 601 Tahoma Road Brownfield, Texas 79316 8066378448 Fax: 8066377749 DOCUMENTATION & NOTIFICATION OF RESTRAINT Student name: School District: Staff Member’s) administering restraint:
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How to fill out FCSSA:

01
Begin by gathering all necessary documents and information, including personal identification, income statements, and any relevant documentation.
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Access the FCSSA application form either online or in paper format, depending on the available options.
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Carefully read and understand the instructions provided on the application form before starting to fill it out.
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Enter your personal information accurately and provide all necessary details, such as your full name, contact information, and social security number.
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Fill out the sections related to your financial information, including income, expenses, assets, and liabilities. Be thorough and accurate to ensure the assessment is as accurate as possible.
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If applicable, provide information about any dependents you have, such as children or elderly parents.
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Attach any required supporting documents, such as income statements, tax returns, or bank statements, as specified in the application instructions.
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Sign and date the completed FCSSA application form, and follow the instructions for submitting it, whether it be online submission or mailing it to the appropriate address.

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FCSSA stands for Foreign Bank and Financial Accounts Report. It is a report filed with the Financial Crimes Enforcement Network (FinCEN) to report foreign financial accounts.
US persons, including individuals, corporations, partnerships, and trusts, who have a financial interest in or signature authority over foreign financial accounts with an aggregate value exceeding $10,000 at any time during the calendar year, are required to file FCSSA.
FCSSA can be filled out electronically through FinCEN's BSA E-Filing system or by using the paper form FinCEN Form 114.
The purpose of FCSSA is to combat money laundering, tax evasion, and other financial crimes by disclosing foreign financial accounts held by US persons.
FCSSA requires information about the account holder, the foreign financial institution, and details about the foreign financial account.
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