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Dhs 3418 Eng Form
Attach proofs. Send copies of proofs. Do not send original documents.
5. Mail or take the form and proofs to your county or tribal agency as soon as you have
completed the form.
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Send in your renewal form right away even if you do not have
all proofs.
If we need more information, we will contact you.
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What will happen if I do not return this form?
Coverage will stop if you do not return this form by the due date.
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