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1. SIGNATURE OF WITNESS ADDRESS NUMBER AND STREET CITY STATE ZIP CODE Form SSA-769-U4 07-2010 EF 07-2010 Use old stock Claims File Privacy Act Notice Collection and Use of Personal Information Sections 205 1631 d 1 and 1872 of the Social Security Act as amended and 20 C. Explanations about these and other reasons why information you provide us may be used are available in Systems of Record Notice SORN 60-0009 Hearings and Appeals Case Control System SSA Office of Disability Adjudication and...
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