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RACE AND NATIONAL ORIGIN IDENTIFICATION OPM Form 1468 Rev 5-82 U.S. Office of Personnel Management FPM Supplement 296-1 Agency Use Only Please read the instructions and Privacy Act Statement before completing form Name Last First Middle Initial Privacy Act Statement Birthdate Month Year employing agency will attempt to identify your race and national origin by visual perception. You are required to furnish this information under the authority of .

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