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DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY REC. #2. Language1. Name of Applicant (last, first, MI)
6. Damaged Phone #DR #O.M.B. No. 16600002
Exp. May 31, 2014
(see reverse
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How to fill out damaged phone
01
Assess the damage: Check if the phone is externally damaged or if it is unresponsive to touch or power on.
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