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Get Hfs Duplicate Mbi Card Claim Form
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How to fill out the HFS Duplicate MBI Card Claim Form online
Filling out the HFS Duplicate MBI Card Claim Form online is a straightforward process that enables you to request a replacement card for yourself or a dependent. This guide will walk you through each section of the form to ensure you complete it accurately and efficiently.
Follow the steps to successfully complete the form
- Click the ‘Get Form’ button to access the form and open it in your preferred document editor.
- Begin by entering the employer’s name in the designated field. This identifies the employer associated with your employment.
- Next, fill in your name as the employee in the provided space. Ensure accuracy to avoid processing delays.
- Enter your complete address, including street address, city, state, and ZIP code. This information is crucial for correspondence.
- Provide your Social Security number. Ensure that this information is accurate as it’s essential for the processing of your request.
- Input your phone number where you can be reached in case there are questions about your form.
- Enter your email address. This will allow for electronic communication regarding your request.
- Fill in the name of the dependent or spouse for whom you are requesting the card. If this is a replacement card for yourself, write the word ‘replacement’ in this field.
- Provide the Social Security number of the dependent or spouse. This information is necessary for identification purposes.
- Enter the date of birth of the dependent or spouse to complete the identification process.
- Be aware that a $5.00 fee is charged for each additional card requested.
- Finally, review all entered information for accuracy. Save your changes, and ensure you print or download the completed form to submit it.
- Mail the completed form along with the payment to HFS at the provided address: HFS (Hirsch Financial Services, Inc.), P.O. Box 1550, Hunt Valley, MD 21030-1550.
Complete your documents online today for a hassle-free experience.
Related links form
If you need a replacement medical card in Illinois, start by visiting the Illinois Medicaid website where you can request a new card. You can also contact the Illinois Medicaid office directly for assistance. Keeping your paperwork organized, including the HFS Duplicate MBI Card Claim Form, can facilitate a smoother replacement process.
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