Social Security
                  Administration
         Medicare
                  Prescription Drug Assistance
         Important
                  Information
          
                                                                                  Great Lakes
            Program Service Center
         
                                                                                  600 West
            Madison Street
         
                                                                                 Chicago, Illinois
            60661-2474
         
                                                                                 Date: November
            1, 2005
         
                                                                                 Social Security
            Number: 123-00-6789
         
          
         JOHN Q. PUBLIC
         123 MAIN ST
         SPRINGFIELD OH 45501
          
          
         On October 20, 2005, you submitted an Application for Help With Medicare Prescription
            Drug Plan Costs. Since we already processed an earlier application for you, we are
            taking no further action on this application.
         
          
         The decision on the first application remains in effect for 12 months unless you have
            a subsidy-changing event. A subsidy changing event is one of the following:
         
          
         
            - 
               
            
- 
               
                  • 
                     you and your spouse who lives with you divorce; 
 
 
- 
               
                  • 
                     your spouse who lives with you dies; 
 
 
- 
               
                  • 
                     you and your spouse separate; 
 
 
- 
               
                  • 
                     you and your spouse have your marriage annulled; or 
 
 
- 
               
                  • 
                     you and your separated spouse begin living together again. 
 
 
 
         If you have a subsidy-changing event, please call us toll-free at 1-800-772-1213.
          
         If You Have Any Questions
          
         For information about Medicare prescription drug plans or other Medicare issues, visit
            www.medicare.gov on the Internet or call toll-free 1-800-MEDICARE (1-800-633-4227). If you are deaf
            or hard of hearing, you may call the Medicare TTY number toll-free at 1-877-486-2048.
         
          
         For information about the extra help with the costs related to Medicare prescription
            drug plans or general information about Social Security, visit our website at www.socialsecurity.gov on the Internet. You may also call Social Security toll-free at 1-800-772-1213. If
            you are deaf or hard of hearing, you may call our TTY number toll-free at 1-800-325-0778.
            We can answer most questions by phone.
         
          
         If you do call, please have this letter with you. It will help us answer your questions.
          
          
          
                                                                                             
            Regional Commissioner