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* 1. Name:

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* 2. Email:

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* 3. Estimated calls by people in this category in the past week:

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* 4. What age groups are you hearing from? Rank age ranges (1, 2, 3):

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* 5. Please list occupations:

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* 6. Anything else you would like to share about requests from unemployed workers ineligible for unemployment insurance?

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