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DocuSign Envelope ID: 25336BC75EFE439AB504F33E9F2EBF0DARLINGTON COUNTY, VIRGINIA AGREEMENT NO. 22DHSEP12 AMENDMENT NUMBER 3 6/14/2022This Amendment Number 3 (Amendment) is made on ___, and amends
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22-dhs-ep-12 is a specific form used within the Department of Human Services to report certain data related to employment or services.
Individuals or entities that engage in specific services or employment related to the Department of Human Services are required to file 22-dhs-ep-12.
To fill out 22-dhs-ep-12, one must provide required personal and organizational information, details about the services or employment, and any relevant data as specified in the form instructions.
The purpose of 22-dhs-ep-12 is to collect necessary information for regulatory compliance and to ensure appropriate oversight of services related to the Department of Human Services.
The information that must be reported includes personal identification details, service descriptions, employment information, and any statistical data pertinent to the services provided.
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