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Get SSA-4734BK 1989

Nts: RFC Assessment Is For: Current Evaluation Date Last Insured: Date 12 Months After Onset: Other(Specify): PRIVACY ACT/PAPERWORK ACT NOTICE: The information requested on this form is authorized by Section 223 and Section 1633 of the Social Security Act. The information provided will be used in making a decision on this claim. Failure to complete this form may result in a delay in processing the claim Information furnished on this form may be disclosed by the Social Security Administration t.

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