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- DOES YOUR FAMILY FIT WITHIN THE ABOVE INCOME GUIDELINES?*
- ARE YOU, OR SOMEONE IN YOUR FAMILY, A CARD CARRYING MEMBER OF A FEDERALLY RECOGNIZED TRIBE?*
- DO YOU CURRENTLY HAVE ANY INSURANCE (OR HAVE ANY OFFERED TO YOU, EVEN IF YOU'RE NOT ENROLLED) SUCH AS: EMPLOYER INSURANCE OR HRA THROUGH YOU OR YOUR SPOUSE'S JOB, VA OR TRICARE, MEDICARE/MEDICAID?*
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- Should be Empty: