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Get MA DTA Electronic Document Management (EDM) Mail/Fax Cover Sheet

Department of Transitional Assistance DTA Electronic Document Management EDM Mail/Fax Cover Sheet Please print clearly. Cover sheets must be originals not copies. Use one cover sheet for each household. Do NOT use the same cover sheet to send items for more than one household. Fax or Mail Information Documents should be sent to the address below mail or fax to avoid a delay in processing. DTA Document Processing Center PO Box 4406 Taunton MA 02780-0420 Fax 617-887-8765 This facsimile transmittal may contain information that is privileged confidential or exempt from disclosure under applicable law is intended for the use of only the individual or department to which it is addressed. If you are not the recipient or the employee or the agent responsible for the delivery of this transmittal to the intended recipient please notify the sender by telephone at the above number and destroy the attached documents. Use this cover sheet when mailing or faxing documents to DTA. Head of Household Information Name Last 4 digits of Soc* Sec* No Date of birth AP ID if applicable No* of pages including cover sheet Sender Phone No Name of Agency if applicable Important Message Do NOT photocopy cover sheets. Cover sheets must be originals not copies. Use one cover sheet for each household. Do NOT use the same cover sheet to send items for more than one household. Fax or Mail Information Documents should be sent to the address below mail or fax to avoid a delay in processing* DTA Document Processing Center PO Box 4406 Taunton MA 02780-0420 Fax 617-887-8765 This facsimile transmittal may contain information that is privileged confidential or exempt from disclosure under applicable law is intended for the use of only the individual or department to which it is addressed* If you are not the recipient or the employee or the agent responsible for the delivery of this transmittal to the intended recipient please notify the sender by telephone at the above number and destroy the attached documents. Anyone other than the intended recipient is hereby notified that any dissemination distribution or copying of this communication is strictly prohibited*. Use this cover sheet when mailing or faxing documents to DTA. Head of Household Information Name Last 4 digits of Soc* Sec* No Date of birth AP ID if applicable No* of pages including cover sheet Sender Phone No Name of Agency if applicable Important Message Do NOT photocopy cover sheets. Cover sheets must be originals not copies. Use one cover sheet for each household. Do NOT use the same cover sheet to send items for more than one household. Fax or Mail Information Documents should be sent to the address below mail or fax to avoid a delay in processing* DTA Document Processing Center PO Box 4406 Taunton MA 02780-0420 Fax 617-887-8765 This facsimile transmittal may contain information that is privileged confidential or exempt from disclosure under applicable law is intended for the use of only the individual or department to which it is addressed* If you are not the recipient or the employee or the agent responsible for the delivery of this transmittal to the intended recipient please notify the sender by telephone at the above number and destroy the attached documents. Anyone other than the intended recipient is hereby notified that any dissemination distribution or copying of this communication is strictly prohibited*. .

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