TN 30 (03-96)
NL 00703.610 Address Change — Returning HI Card
Document Identifier for Word Processor: E3610
A. EXHIBIT LETTER
We have changed your address as you requested and are returning your health insurance card.
You may use this card no matter how many times you change your address. Please do not return the card when you notify us of another change in your address.
Health Insurance Card
B. REQUESTING INSTRUCTIONS
This notice is used to inform the beneficiary that we have changed the address as requested and we are returning his/her health insurance card.
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-3296-EP in file. No fill-ins are required.