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FOR BHF USELL2Supportive Living FacilityIMPORTANT NOTICE THIS AGENCY IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY TO ACCOMPLISH THE STATUTORY PURPOSE AS OUTLINED IN SECTION 146.265 OF

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01

To fill out this agency request, follow these steps:

02

Start by providing your personal information, such as your name, contact information, and address.

03

Next, specify the type of agency you are requesting, such as a government agency, healthcare agency, or educational agency.

04

Provide details about the specific services or assistance you are seeking from the agency.

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Who needs this agency is requesting?

01

Any individual or organization requiring specific services, assistance, or support from an agency may need to fill out this agency request.

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What is this agency is requesting?

This agency is requesting specific information for a report.

Who is required to file this agency is requesting?

Anyone who meets the criteria set by the agency is required to file.

How to fill out this agency is requesting?

The agency provides a form or online portal for individuals to fill out and submit the required information.

What is the purpose of this agency is requesting?

The purpose of this request is to gather data for analysis or regulatory compliance.

What information must be reported on this agency is requesting?

The agency requires information such as personal details, financial data, or other specific data points.

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