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| Received Date |
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Spousal Cooperation Details
Complete if the individual has indicated that their spouse has refused to co-operate in making their assets available to the individual.
| Household Member |
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| Spouse Refuse to Co-Operate | |||
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| Non Compliance Reason |
Indicate if the individual has assigned the rights to the state to pursue the spouse for the assets.
| Assign Rights | |||||||
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| Start Date |
| End Date |
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Spouse Details
If the spouse is a case participant, please select from below.
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If the spouse is not a case participant but is registered on the system, please select from below.
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If the spouse is not registered on the system, complete the spouse details below.
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