Social Security Administration
Medicare Prescription Drug Assistance
Important Information
Social Security Administration
Field Office Return Address
Date: November 1, 2005
Social Security
Number: 123-00-6789
JOHN Q. PUBLIC
123 MAIN ST
SPRINGFIELD OH 45501
On October 25, 2005, you submitted an Application for Help With Medicare Prescription
Drug Plan Costs. Since this application raises no new issues and we processed an earlier
application for you, we are taking no further action on this application.
If you disagree with the decision we made on your earlier application, you need to
file an appeal. You may file an appeal by calling us toll-free at 1-800-772-1213.
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.
Field
Office Manager