Home care worker application oregon

    • [PDF File]SS-4 Application for Employer Identification Number

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      Form SS-4 (Rev. December 2017) Department of the Treasury Internal Revenue Service . Application for Employer Identification Number (For use by employers, corporations, partnerships, trusts, estates, churches,

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    • [PDF File](Do not write in this space) APPLICATION FOR DISABILITY ...

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      APPLICATION FOR DISABILITY INSURANCE BENEFITS. Page 1 of 7 OMB No. 0960-0618. I apply for a period of disability and/or all insurance benefits for which I am eligible under Title II and Part A of Title XVIII of the Social Security Act, as presently amended. (Do not write in this space) 1. PRINT your name. FIRST NAME, MIDDLE INITIAL, LAST NAME 2.

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    • [PDF File]CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

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      certificate holder © 1988-2010 acord corporation. all rights reserved. acord 25 (2010/05) authorized representative cancellation certificate of liability insurance ...

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    • [PDF File]Patient Health Questionnaire (PHQ-9)

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      home and bring them in at their next appointment for scoring or they may complete the questionnaire during each scheduled appointment. 2. Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3 3. Add together column scores to get a TOTAL score. 4.

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    • [PDF File]Statement of Death by Funeral Director

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      SOCIAL SECURITY ADMINISTRATION. STATEMENT OF DEATH BY FUNERAL DIRECTOR. Form Approved OMB No. 0960-0142. ... this statement may be used in connection with an application for Social Security benefits. I declare under penalty of perjury that I have ... The deceased worker's parents age 62 or older, if they were being supported by the worker.

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    • [PDF File]Application for Social Security Card

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      Application for a Social Security Card. ... Social Security record, show the date of birth currently shown on your record in item 13 and provide evidence to support the date of birth shown in item 4. 16. Show an address where you can receive your card 7 to 14 days from now. 17. WHO CAN SIGN THE APPLICATION?

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    • [PDF File]Form 433-F (February 2019) Collection Information Statement

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      home. Include insurance and taxes if they are included in your monthly payment. The county/description is needed if different than the address and county you listed above. To determine equity, subtract the amount owed for each piece of real estate from its current market value.

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    • [PDF File]2018 Schedule SE (Form 1040)

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      Schedule SE (Form 1040) 2018. Attachment Sequence No. 17. Page . 2 . Name of person with. self-employment. income (as shown on Form 1040 or Form 1040NR) Social security number of person

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    • [PDF File]Form W-9 (Rev. October 2018)

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      • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

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    • [PDF File]Request for Leave or Approved Absence

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      Care of family member, including medical/dental/optical examination of family member, or bereavement: Care of family member with a serious health condition ... delay or prevent action on the application. If your agency uses the information furnished on this form for purposes other than those indicated above, it may

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