Official State of Rhode Island website

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State of Rhode Island Office of Rehabilitation Services Department of Human Services

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I understand that all of the information will be kept confidential and will only be used as required for assistance, reports, and audits. By sending this form, it authorizes the ATEL Program to contact VERIZON to verify telephone service.

I hereby certify that all of the statements made by me on this electronic form are true and correct to the best of my knowledge and belief. As long as I am receiving services, I agree to notify the agency if there is any change of the information furnished on this form.

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