Consumer Fiscal Responsibilities Agreement

Document Number:  DVR-16843-E

Description:  This form is to be completed by DVR Staff members and Consumers regarding fiscal services provided by DVR.

Comments:  This form is protected from modification and enabled for form fill (includes tabbed fields for form completion).

Content Contact:  Audrey Merten

Document Attachments:

DVR-16843-E (English Electronic Version - Word/45 KB)

DVR-16843-E-H (Hmong Electronic Version - Word/47 KB)

DVR-16843-E-S (Spanish Electronic Version - Word/43 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.

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