Name (first, last) Do not enter your name or spouse’s name below
(a)
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Date of Birth (mm/dd/yy)
(b)
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Relationship to you (for example: son, daughter, parent, none, etc)
(c)
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Number of months lived in your home last year
(d)
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US Citizen (yes/no)
(e)
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Resident of US, Canada, or Mexico last year (yes/no)
(f)
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Single or Married as of 2018 (S/M)
(g)
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Full-time Student last year (yes/no) (h)
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Totally and Permanently Disabled (yes/no) (i)
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