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CHILD CARE APPLICATION

Si necesita esta aplicación en idioma español, llame al 1-800-476-0199 por favor. PLEASE COMPLETE IN BLUE OR BLACK INKAND COMPLETE ALLSECTIONS DSS Form 3791 (MAY 19) Edition of a APR 16 is obsolete. n Y n N n Single Parent Family n Two Parent Family n Single Parent Guardian/In Loco Parentis n Two Parent Guardian/In Loco Parentis

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  Applications, Care, Child, 0199, Child care application

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