care authorized representative
Application for Cash or Food Assistance
Yes. No. You may need to complete the Authorized Representative form (DSHS 14-532). NAME. RELATIONSHIP. TELEPHONE NUMBER. MAILING ADDRESS. CITY. STATE. ZIP CODE.
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14-532 Authorized Representative
An Authorized Representative is someone you designate to represent you when you apply for or receive benefits with the. Department of Social and Health
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NRC Supplementary Information for General Licensees of
(14) Shall report changes to the mailing address for the location of use PH (615)532-0364. FX (615)532-0614 debra.shults@tn.gov. Texas. Charlotte Sullivan
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