BASIC (05-05)

HI 03094.601 Application Receipt

A. Purpose/Use

An application receipt is generated as a receipt for all subsidy applications scanned in Wilkes-Barre or processed through MAPS in the field office.

B. Sample Subsidy Application Receipt

Social Security Administration

Medicare Prescription Drug Assistance

Receipt of Application

Wilkes-Barre Data Operation Center

  PO Box 1020

Wilkes-Barre, PA 18767-1020

    Date: November 5, 2005

  Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

                                  This is a Receipt for Your Application for

                         Help With Medicare Prescription Drug Plan Costs

We received your Application for Help with Medicare Prescription Drug Plan Costs and will process it as quickly as possible. We will contact you if we need more information.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094601
HI 03094.601 - Application Receipt - 07/07/2006
Batch run: 01/27/2009
Rev:07/07/2006