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For voluntary Federal Income Tax withholding from disability benefit payments. Ask your Doctor to complete an Attending Physician's Statement. Submit these completed forms according to the directions you received from your Benefits Office. The Prudential Insurance Company of America Disability Management Services P0 Box 13480, Philadelphia, PA 19101 Voice: 1-800-842-1718 Facsimile: 1-877-889-4885 For your protection, certain state laws require the following to appear on this form: California R.
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