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SSA Submit Disclaimer for Form and Email

Disclaimer for Form:

The form link on this page is provided for your general use only. This form is not monitored by the County and/or Social Services Agency on a regular basis. By using this form, you are consenting to self-disclose information about yourself or family to the Social Services Agency. The privacy and security of your information is very important to us; therefore, we have reasonable controls in place to protect your information once the form is submitted. Prior to your submission, the County and Social Services Agency is not responsible or liable for any direct, indirect, incidental or inadvertent issue with the privacy and security to your data as a result of use or inability to use this form on this site. For us to provide assistance or respond to you, we will need all the required fields to be completed. If the form is incomplete, this will delay our ability to assist or respond to you.


Disclaimer: In the event of a medical emergency, call 911.