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Get Entouch Recertification Form

Ials Required: Initial Initial Initial Initial Initial Initial Initial Initial I hereby certify nder penalty of perjury that: u 1. I (or my dependent or other member of my household) currently receive(s) benefits from the federal program(s) identified or my annual household income is at or below 135 percent of the Federal Poverty Guidelines (or the amount that applies to my state as indicated in the chart on page 1). 2. I understand that I must notify my service provider within 30 da.

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