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CHANGE REPORT FORM FOR FOOD STAMP NON …

CHANGE REPORT FORM FOR FOOD STAMP NON

www.bcbss.org

FSP-922 (Rev. 5/10) (Page 1) CHANGE REPORT FORM FOR FOOD STAMP NON-SIMPLIFIED REPORTING CASES This form is to be used to notify your food stamp office of any changes in your household's circumstances.

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