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APPLICATION FOR SHORT TERM DISABILITY INCOME BENEFITS EMPLOYEE S STATEMENT Section II To Be Completed by the Employee (BE SURE TO ANSWER ALL QUESTIONS. FAILURE TO DO SO MAY DELAY YOUR CLAIM) A. Information
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John P. Dempsey WS stands for John P. Dempsey Worksheet, which is a form used to report financial information for individuals.
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Information such as income, expenses, assets, and liabilities must be reported on the John P. Dempsey WS.
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