TN 23 (12-17)

NL 00725.205 “DID” UTIs

DID029 Request for Change in Mailing Address/Direct Deposit Information for ALJ Level Award Notices upon Effectuation

Please tell us if  (1)  mailing address or direct deposit information changes. We need this information to deposit  (2)  payments on time and send you important letters about  (3)  payments.

(1) “your”/FN possessive
(2) “your”/“his”/“her”
(3) “your”/“his”/“her”

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NL 00725.205 - “DID” UTIs - 12/21/2017
Batch run: 12/21/2017