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Advocate/Intake Worker Helpline Retainer Script Read to Client? Y N Name/Date Last/Client Agrees? Y N First M.I. Address City/Zip Telephone (SS# Ethnicity:)County Email: DOB/Sex: Male Female/Other
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Anyone who requires certain services or actions from the Arkansas Department may need to fill out r - Arkansas department. The specific individuals who need to fill out this form may vary depending on the purpose and requirements set by the department. It is recommended to check the instructions or contact the Arkansas Department directly to determine if you need to fill out this form for your specific situation.
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R - Arkansas Department refers to the form or document filed with the Arkansas Department of Revenue for tax purposes.
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