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Form Approved OMB No. 05600289 Expiration Date: 04×30/2023 1. County FSA Name and Address (Including Zip Code×This form is available electronically U.S. DEPARTMENT OF AGRICULTURE Commodity Credit
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Open your web browser and go to the website www.hhs.gov/socr/
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The Office for Civil Rights (OCR) ensures that the U.S. Department of Health and Human Services (HHS) complies with civil rights laws.
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Protected Health Information (PHI) and any security breaches or violations.
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