Illinois state school report card
[PDF File]Application for Social Security Card
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9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST show the parents' Social Security numbers unless the parent was never assigned a Social Security number. If the number is not known and you cannot obtain it, check the “unknown” box. 13.
[PDF File]USCIS Form I-9
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School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 4. Voter's registration card 5.
[PDF File]MEDICARE CREDIT BALANCE REPORT
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may arise with respect to the credit balance data. Complete the data fields for each Medicare credit balance by providing the following information (when a credit balance is the result of a duplicate Medicare primary payment, report the data pertaining to the most recently paid claim):
[PDF File]Form W-9 (Rev. October 2018)
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City, state, and ZIP code. Requester’s name and address (optional) 7. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN).
[PDF File]Request for Social Security Earnings Information
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necessary if you are making payment by credit card. You do not need to fill out the credit card information if you choose another means of payment (for example, by check or money order). If you choose the credit card payment option, we will provide the information you give us to the banks handling your credit card account and the Social Security
[PDF File]Mini-Mental State Examination
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Abnormal for high school education Abnormal for college education Severity 24-30 18-23 0-17 No cognitive impairment Mild cognitive impairment Severe cognitive impairment Sources: • Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state examination by age and educational level. JAMA. 1993;269(18):2386-2391
[PDF File]Request for Leave or Approved Absence
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Request for Leave or Approved Absence. 1. Name (Last, first, middle) 2. Employee or Social Security Number (Enter only the last 4 digits of the Social Security Number (SSN))
[PDF File]Form I-693, Report of Medical Examination and Vaccination ...
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Report of Medical Examination and Vaccination Record . Department of Homeland Security . U.S. Citizenship and Immigration Services . USCIS Form I-693 . OMB No. 1615-0033 Expires 07/31/2022 START HERE - Type or print in black ink. Part 1.€ Information About You€ (To be completed by the person requesting a medical examination, NOT. the civil ...
[PDF File]2018 Form 1040
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Form 1040 Department of the Treasury—Internal Revenue Service . U.S. Individual Income Tax Return . 2018. OMB No. 1545-0074. IRS Use Only—Do not write or staple in this space.
[PDF File]Patient Health Questionnaire (PHQ-9)
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Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient.
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