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If you need help with this form, you can call Member Services at 800-700-3874, Monday-Friday, 8 a.m. to 5:30 p.m. If you need language assistance, we have a special telephone line to get an interpreter who speaks your language at no cost to you.

For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: شماره گیری کنید 711).