Transcription of TANF SERVICES CERTIFICATION
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LDSS-4770 (Rev. 2/16) TANF SERVICES Eligible Statuses and Proof 1 TANF YOUTH SERVICES APPLICATION The information requested on this form is necessary to determine whether or not federal Temporary Assistance for Needy Families (TANF) funds may be used to provide SERVICES to you. This application form may be used by an applicant for SERVICES who is under 21 years of age. _____ SECTION ONE A. Information About the Youth Applicant 1. Applicant s Name: _____ Home Address: _____ (Street) (Apartment Number) _____ (City) (State) (Zip Code) Social Security Number
LDSS-4770 (Rev. 2/16) TANF Services Eligible Statuses and Proof 3 SECTION FIVE TANF Youth Services Application Review Form CERTIFICATION ITEM Yes …
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FOOD STAMP/MEDICAID/TANF Renewal Form, Georgia, Services FOOD STAMP/MEDICAID/TANF Renewal Form, TANF, Temporary Assistance for Needy Families, TANF) Block Grant, Georgia Department of Human Services Application, Virginia, Services, Application for Benefits, NEVADA STATE DIVISION OF WELFARE, NEVADA STATE DIVISION OF WELFARE AND SUPPORTIVE SERVICES INFORMATION, TEMPORARY CASH ASSISTANCE, Application