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Form SSA-5665-BK Page 1 of 10 OMB No. 0960 …
Website URL:
http://www.ssa.gov/forms/ssa-5665.pdf
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Form . SSA-5665-BK (06-2018) UF. Page 2 of 10. Sections 202, 223 and 1631(e) of the Social Security Act, as amended, allow us to collect this information.
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