Statement of Facts

The statement of facts must be filled out as part of the application packet. The eligibility worker needs to use information stated here in determining eligibility for benefits. Information stated here will be verified during the interview process. It is highly recommended that verification documents be brought in during the interview that would prove what has been stated in this document to facilitate expeditious processing. This document is also available in the different languages listed below. Click on the links to view and download the document in your preferred language.

English      

Chinese     

Russian      

Spanish      

Vietnamese

Note:

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