Form Rfa 09 - Notice Of Action Regarding Resource Family Approval Page 4

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[This page to be kept attached only for appeals that will go to SHD. For OAH cases, please detach before serving.]
[For County use only. Do not write in this box.]
County: __________________________________________ County RF ID#: ______________
[County: Enter type of action from page 1 here.]
[Forum: SHD___ OAH___]
RFA 09 (1/18)
Page 4 of ____

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