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Application and Recertification Documentation Submission
Please use the following form to submit any documentation for applications and recertifications.
Name
*
First Name
Last Name
CBMS Number and Social Security Number
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Is it ok to text you?
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
The following documentation may be required to process your application
Social Security number for all household members
Proof of monthly income
Identification for the Head of Household
Proof of basic expenses, such as
Child care costs, if applicable
Child support being paid, if applicable
If over 60 years of age, or disabled as defined by the Social Security Administration, you may also need to provide proof of medical expenses over $35.00, if applicable.
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