Po box 29225 mail drop 5895-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Claimant Information. Fill in your name as it appears on the claim, including your last name, first name, and middle initial.
3. Next, provide your Social Security Number in the designated field to ensure accurate processing of your request.
4. If you are changing your legal name, enter your new legal name in the appropriate fields (Last, First, M.I.).
5. Update your address by filling in the New Address section with your street number, street name, city, state, and zip code.
6. Sign the form where indicated to confirm that all information is correct and complete.
7. Finally, include your phone number and date before submitting the form via fax or mail as instructed.

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