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Get Dds Annual Family Program Fee

009 (08/2011) Reset Save As Print Welfare and Institutions Code Section 4785 requires parents of qualifying children under 18 years of age to pay an annual family program fee based on adjusted gross family income. Assessed Amount $ Assessment Date: Please complete the following information. Consumer Name(s) RC # PARENT - 1 UCI # Date of Birth PARENT - 2 Social Security Number - Social Security Number - Name First MI Last.

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  • qualifying
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