Form 1 Request for Participation

Annual Survey of Refugees

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OMB Number: 0970-0033

Expiration Date: xx/xx/xxxx

ADMINISTRATION FOR CHILDREN AND FAMILIES

370 L’Enfant Promenade, S.W.

Washington, D.C. 20447

Sincerely,

David H. Siegel

Acting Director

Office of Refugee Resettlement

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