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Get Ssa Form Fill Dropout Child Detail

Form Approved OMB No. 0960-0474 Social Security Administration See Paperwork/Privacy Act Notice on Reverse CHILD-CARE DROPOUT QUESTIONNAIRE NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON SOCIAL SECURITY NUMBER NAME OF PERSON MAKING STATEMENT If other than above wage earner or self-employed person RELATIONSHIP TO WAGE EARNER OR SELF-EMPLOYED PERSON Was a child either your own or your spouse s living with you while the child was under age 3 in any yea.

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