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Get CA HHSA SSP 14 2010-2022

IAL SECURITY NUMBER CITY/TOWN ADDRESS COUNTY IA AGENCY ZIP CODE GR CODE For the purpose of this Authorization Form: The term “State” means the California county interim assistance (IA) agency (s) that the California Department of Social Services has an interim assistance reimbursement agreement with and that paid you public assistance. The term “SSI/SSP benefits” means “Supplemental Security Income/State Supplementary Payment” benefits under Title XVI of the Social Security Act.

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