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Proof of Eligibility:
Guidelines and Examples

Online Portal Screenshot/Print out

Must have the name of the program, the customer’s name* and an issue date within the last 12 months
or a future expiration date.

*It is acceptable if it only has the first name or first name and middle initial. Verify that the last 4 digits
of the SSN and DOB match the application.

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Proprietary and Confidential 1/20/2020