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Get SSA-3881-BK 2011

Ices? u Yes No If "yes," describe services received below the rehabilitation counselor's information. Include dates and record number. Rehabilitation Counselor's Name Telephone No. (including Area Code) Address (Number, Street, City, State, ZIP Code) Services received: (If additional space is needed, use "REMARKS" section.) NOTE: PROVIDING INFORMATION ABOUT THE CHILD'S INVOLVEMENT WITH THE COURT SYSTEM IS OPTIONAL 8. Has the child ever been involved with the court system other than in c.

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