Attachment 10 -- HC MEPS Change of Address Card

Seal card with this label
before mailing.

Change of Address and Telephone Notification
If your address on the envelope is incorrect, if you plan to move, or if your telephone number has changed,
please complete the information below and drop this card in a mailbox. NO POSTAGE IS NEEDED. If you
prefer, call Alex Scott at our toll-free number: 1-800-945-MEPS (6377).
Your Name

First

Middle

Last

OLD ADDRESS

NEW ADDRESS

Street Address
City

State

Telephone Number (

Street Address
Zip

)

City

State

Telephone Number (

Date of Move
Month

Day

Year

)

Zip

OMB #0935-0118

09-105

fim codeNO
C POSTAGE
RE 323

*7690.01.01$.65*

BUSINESS REPLY MAIL

FIRST CLASS PERMIT NO. 433 ROCKVILLE, MD
POSTAGE WILL BE PAID BY ADDRESSEE

Medical Expenditure Panel Survey
c/o Westat
1650 Research Blvd.
Rockville, MD 20850-9973

NECESSARY
IF MAILED
IN THE
UNITED STATES