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We anticipate that the time expended by all individuals who complete this form will average 10 minutes. This includes the time it will take to read instructions gather the necessary facts and complete the form* This information is collected under the authority of Title 38 Part II Sections 1710 and 1730. This information is used to determine your qualifications to provide Long-Term Care. Although this information is voluntary failure to provide it will delay or prevent our approval of your agenc ...

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