WRITTEN STATEMENT REGARDING SECTION 223(d)(5)(C) OF THE SOCIAL SECURITY ACT – DO NOT REMOVE I, [Name and Title], was imposed with a civil monetary penalty, an assessment, or both, for submitting false evidence, under section 1129 of the Social Security Act, on [Date of Final Decision imposing Civil Monetary Penalty, Assessment, or Both].
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File Created | 0000-00-00 |