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MEMORANDUM PLACER COUNTY HEALTH AND HUMAN SERVICES TO: Honorable Board of Supervisors FROM: Richard J. Burton, M.D., M.P.H. Health Officer and Director of Health & Human Services Bradford R. Pinocchio

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5. If there are any specific questions or sections that you are unsure about, seek assistance from a professional or someone who is familiar with the form. Accuracy is essential to ensure that you receive the appropriate services or benefits.
6. Once you have completed filling out the form, review it carefully to check for any missing or inconsistent information. It is essential to ensure the accuracy of the details provided.
7. If the form requires signatures, make sure you sign and date it appropriately. This will validate your submission and indicate your understanding and consent to the information provided.

Who needs Richard Burton CDSS form:

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