ADDENDUM 9

Social Security Enumeration Request Letter Template

Date:

To:             Social Security Administration

From:         Division of Public Assistance

The persons listed below meet all the requirements for Medicaid benefits except for having a Social Security Number.  This letter is written to comply with the documentation described in Social Security POMS RM 10211.600, "Request for an SSN from an Alien without Work Authorization."

Please issue a non-work number and supply the SSN applicant with a receipt / acknowledgment of the request for our tracking purposes.

CLIENT NAME            DATE OF BIRTH              CLIENT IDENTIFICATION NUMBER

Please e-mail hss.dpa.office@alaska.gov or call me at the number below if any further information is needed.

Sincerely,

Division of Public Assistance

State of Alaska

800-478-7778

cc: file