Get MD DHR/FIA 4350 2013-2021
funds to an individual who has been certified for a licensed assisted living program, a CARE home, or a Department of Health and Mental Hygiene (DHMH) rehabilitative residence. SECTION I REPRESENTATIVE PAYEE’S AGREEMENT In becoming a Representative Payee for __________________________ ___________________ (Name of Customer) (Customer ID) I understand and agree to the following: 1. To use the assistance payment to obtain shelter, food, clothing, etc. for the customer. 2. To provide some a.
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