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Form G-478 Statement Regarding Patient's Capability to Manage Payme
Application to Act as Representative Payee
Form G-478 (03-17)
Statement Regarding Patient's Capability to Manage Payments
OMB: 3220-0052
OMB.report
RRB
OMB 3220-0052
ICR 202303-3220-001
IC 179885
Form G-478 Statement Regarding Patient's Capability to Manage Payme
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