BASIC (05-05)

A. Purpose/Use

The “Duplicate Subsidy Application on Award” notice is sent to the applicant when a subsequent application is received on a full award during or after the appeal period. It is also sent when a subsequent application is received on a partial award after the appeal period. The notice explains that the determination will not be changed unless the recipient has a subsidy changing event. This notice is available through MAPS.

B. Sample Notice for Duplicate Subsidy Application on Award

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 get married;

• 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