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    Request for Information

    Who Gets this Notice

    Consumers who need to provide more information about a change they have submitted to their MNsure application.

    What You Need to Do

    • Send MNsure the requested documentation by the due date. The due date is on the first page, under the heading, “What do I need to do?”
    • Do not delay. MNsure cannot process changes to your application until we receive this documentation. A delay could end your coverage, cost-sharing reductions or tax credits.

    How to Identify this Notice

    On the first page of this notice you will see:

    • The MNsure logo.
    • A headline that reads, "ACTION REQUIRED: DOCUMENTATION IS NEEDED."
    • "MNsure 4843B Form" on the lower left.

    This notice may be 10 or more pages long. There is a table for each person that needs to provide more information.

    Example table: "Need more information"
    Needed Information Supporting Documents
    Examples:
    Proof of citizenship
    Social Security number    		 Documents that are accepted as proof of the information needed. Examples:
    U.S. passport
    State driver’s license

    Questions

    If you have questions about this notice, call the MNsure Contact Center at 651-539-2099 (855-366-7873 outside the Twin Cities) and reference "form 4843B."

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