TN 30 (03-96)
NL 00703.609 New Health Insurance Card As A Result of Requested Changes
Document Identifier for Word Process: E3609
A. EXHIBIT LETTER
Thank you for advising us of the change required on the health insurance card you received. We have taken the necessary steps to correct the information.
You will receive a new card shortly to replace the one which is incorrect.
B. REQUESTING INSTRUCTIONS
This notice is used to notify a beneficiary that a new HI card will be sent to him/her with the changes requested.
C. TYPING INSTRUCTIONS
Information for this letter will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-C2 in file.