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Get the free policies.ncdhhs.gov formfile dss-8178L-iaLOW INCOME ENERGY ASSISTANCE PROGRAM APPLIC...

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TRACEY BELTON DIRECTOR SAN BENITO COUNTY Health & Human Services AgencyCOMMUNITY SERVICES & WORKFORCE DEVELOPMENT1161 SAN FELIPE ROAD, BUILDING B HOLLISTER, CA 95023 ×831× 6379293 FAX (831) 6340785COMMUNITY
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It is a form used to report low income information for a specific program.
Individuals who meet the low income criteria set by the program.
The form must be completed with accurate low income information and submitted to the appropriate authority.
The purpose is to determine eligibility for a specific program based on low income criteria.
Income details, household size, and other relevant financial information.
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