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statements or forms, and it is true and correct to the best of my knowledge. By signing below, I agree to the terms of this IWP and give my permission to _______________________ to contact employers on my behalf to verify or obtain evidence of work or earnings. Beneficiary's Signature: EN Representative's Signature: Date: Date: Privacy Act Statement Collection and Use of Personal Information Section 1148, of the Social Security Act, as amended, authorizes us to collect this information. The.

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