Take 5 numbers results
[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]Patient Health Questionnaire (PHQ-9)
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your work, take care of things at home, or get along with other people? 10. Somewhat difficult ... 5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of ... Patient Health Questionnaire (PHQ-9)
[PDF File]Form W-9 (Rev. October 2018)
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5. Address (number, street, and apt. or suite no.) See instructions. 6. 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.
[PDF File]VAMC SLUMS Examination - Saint Louis University
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0-4 animals 5-9 animals 10-14 animals 15+ animals 7. What were the five objects I asked you to remember? 1 point for each one correct. 8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say …
[PDF File]Edinburgh Postnatal Depression Scale (EPDS)
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*5 I have felt scared or panicky for no very good reason Yes, quite a lot *10 The thought of harming myself has occurred to me Yes, sometimes Yes, quite often No, not much Sometimes No, not at all Hardly ever Never Administered/Reviewed by _____ Date _____
[PDF File]Request for Social Security Earnings Information
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display a valid Office of Management and Budget control number. We estimate that it will take about 11 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
[PDF File]Scoring Instructions for NICHQ Vanderbilt Assessment Scales
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Scoring Instructions for NICHQ Vanderbilt Assessment Scales ASSESSMENT AND DIAGNOSIS Page 2 of 2 The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care.Variations, taking into account individual circumstances, may be appropriate.
[PDF File]National Interagency Coordination Center Friday, October ...
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FIRES 1 1 5 5 16 122 150 ACRES 5 735 2,261 149 2,111 13,219 18,480 Southern California Area FIRES 1 5 5 4 0 114 129 ACRES 1 159 918 736 0 8,671 10,485 Northern Rockies Area FIRES 9 18 41 12 44 345 469 ACRES 3,567 7,499 12,377 5,124 1,703 30,861 61,131 Great Basin Area FIRES 3 14 11 10 42 90 170
[PDF File]Form 4506-T (Rev. 6-2019)
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transcript. See Line 5 instructions for specific requirements. The customer file number is an optional field and not required. Tip. Use Form 4506, Request for Copy of Tax Return, to request copies of tax returns. Automated transcript request. You can quickly request transcripts by …
[PDF File]Declaration for Federal Employment* OMB No. 3206-0182
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Declaration for Federal Employment* (*This form may also be used to assess fitness for federal contract employment) Form Approved: OMB No. 3206-0182 U.S. Office of Personnel Management. 5 U.S.C. 1302, 3301, 3304, 3328 & 8716
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