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[PDF File]Patient Health Questionnaire (PHQ-9)
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PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME: DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day (use " ü " to indicate your answer) 1. Little interest or pleasure in doing things 0 1 2 3

REG 256, Statement of Facts
Title: REG 256, Statement of Facts Author: CA DMV Subject: Index ready This form is used in a variety of situations, such as, but not limited to:\nUse Tax Exemption Statement \nSmog Exemption Statement \nTransfer Only or Title Only Statement \nWindow Decal for Wheelchair Lift or Wheelchair Carrier \nVehicle Body Change Statement \(Ownership Certificate Required\) \nName Statement \(Ownership ...

Optional Form 1164 - Claim for Reimbursement for ...
and that payment or credit has not been received by me. DATE. CLAIMANT SIGN HERE. 11. CASH PAYMENT RECEIPT. a. PAYEE (Signature) b. DATE RECEIVED c. AMOUNT. 12. PAYMENT MADE BY CHECK NUMBER. Sign Original Only. DATE. Sign Original Only. Sign Original Only. DATE. 9. This claim is certified correct and proper for payment.

[PDF File]Form 941 for 2019: Employer’s QUARTERLY Federal Tax Return
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Form 941-V, Payment Voucher. Purpose of Form. Complete Form 941-V if you're making a payment with Form 941. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Making Payments With Form 941. To avoid a penalty, make your payment with Form 941 . only if:

[PDF File]Practitioner and Provider Compliant and Appeal Request
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Practitioner and Provider Complaint and Appeal Request NOTE: Completion of this form is mandatory. To obtain a review submit this form as well as information that …

[PDF File]Removal and/or Inspection of a Motor Vehicle at a VSF
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conforming identification, a VSF may not delay release or inspection of the vehicle. VSF’S must accept facsimiles or copies of this document FAMILY MEMBERS An immediate family member of the owner of the vehicle may remove or inspect the vehicle using this form and: 1. checking Box 1 in Section One; 2. checking the appropriate box in Section Two;

[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]Health Benefits Election Form
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Health Benefits Election Form Form Approved: OMB No. 3206-0160 Standard Form 2809 ... If you are separated but not divorced, you are still married. Item 7. If you have Medicare, check which Parts you have, including prescription drug coverage under Medicare Part D.

[PDF File]8821 Tax Information Authorization OMB No. 1545-1165
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If the tax information authorization is for a specific use not recorded on CAF, check this box. See the instructions. If you check this box, skip lines 5 and 6 . . . . . .

[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))

Not using the word i