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S REQUEST FOR CERTIFICATION (VRC) FORM IMPORTANT: All requested information must be completed and this form signed in order to process your certification. This form must be submitted to the Enrollment Information Center in the SSA building or faxed to (510) 885-3816. Certification beyond this term is NOT automatic. It is your responsibility to ensure that your benefits continue by submitting the VRC each quarter. All correspondence regarding your benefits will be sent to your HORIZON email acco.

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