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OMB Control No: 09700474 Expiration date: 04/30/2022DEPARTMENT OF HEALTH & HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES 330 C Street S.W., Washington D.C. 20201U. S. REPATRIATION PROGRAM

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Obtain a copy of the form from the Department of Health website or office.

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It is advisable to contact the Department of Health or consult specific guidelines to determine if you need to fill out the form.

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