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State of CaliforniaHealth and Human Services AgencyDepartment of Developmental ServicesNOTICE OF PRIVACY PRACTICES DS 5856A (Rev. 08/2017) Page 1 of 6 Facility Name THIS NOTICE DESCRIBES HOW MEDICAL
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DS 5856A Rev is a form used by the U.S. Department of State for reporting certain financial interests.
U.S. government employees and officials who meet specific criteria are required to file DS 5856A Rev.
DS 5856A Rev can be filled out electronically or manually, following the instructions provided by the U.S. Department of State.
The purpose of DS 5856A Rev is to disclose financial interests that may pose a conflict of interest for U.S. government employees.
DS 5856A Rev requires reporting of financial interests, such as investments, debts, and sources of income.
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