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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES ASSISTANCE DOG SPECIAL ALLOWANCE ADSA APPLICATION FOR SOCIAL SECURITY DISABILITY INSURANCE SSDI RECIPIENTS Department of Social Services - Office of Services to the Blind 744 P Street MS 8-16-94 Sacramento CA 95814 Phone 916 657-2628 / TTY 916 651-6248 PERSONAL INFORMATION Birthdate Name First Middle Last Zip code City Home address Home phone Are you M....

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