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Iowa Department of Human Services Forms

Iowa Department of Human Services Forms

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6. Send the form to us at the address above by Use extra paper, if needed for your answers. What if I have questions? Call your worker at . We will accept collect calls. Household Members These people get benefits with you or are counted to figure your benefits. Please fill in any missing information in the table below. Cross out any information that is not correct about members of your household. Write in any new information. Name/State ID or CIN Birth Date 470-5168 (Rev. 12/15)...
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