COMMONWEALTH OF PENNSYLVANIA Application for …

sign and date this application. 2. Mail, fax or take this application to your local CCIS agency. Call 1-877-PA-KIDS (1-877-472-5437) if you do not know where to send this application or you help with this application. If you are hearing impaired, you can use your TTY service to call 1-877-PA-KIDS (1-877-472-5437). VERY IMPORTANT:

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