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Get Verification Of Benefits Dpss

Rize DPSS/GAIN CALWORKs to release the following information to Long Beach City College-CalWORKs. Participant s Signature: Date: GAIN PARTICIPANT INFORMATION Phone No.: Student ID: Participant Name: Address: Case No.: GAIN WORKER INFORMATION Phone No.: Fax No: GAIN Worker s Name: File Unit No.: **************************************************************************************** The section below must be completed.

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