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Form Approved OMB No. 2900-0673 Respondent Burden 5 Minutes REQUEST FOR PERSONAL IDENTITY VERIFICATION CARD PRIVACY ACT STATEMENT VA is authorized to ask for the information requested on this form by Homeland Security Presidential Directive HSPD -12 and 31 USC 7701. APPLICANT S REQUEST FOR PERSONAL IDENTITY VERIFICATION CARD ACTION TAKEN DENIED APPROVED above listed documents appear to be genuine and to relate to the person named. VA FORM 0711 OC.

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