Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Learn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 plan for New York. Check eligibility, explore benefits, and enroll today. H0271 - 060 - 2 Click to see other plans. Member Services: 1-800-514-4912 TTY users 711. — Enrollment Options —. Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete Choice (PPO D-SNP) benefit details.H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP NeitherCSNY23PP0049825_000 Página 1 de 8 Solicitud de Inscripción 2023 o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul)We would like to show you a description here but the site won’t allow us.UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-001 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. Plan ID: H0271-060-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ...UnitedHealthcare Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium. o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ FemeninoY0066_EOC_H0271_060_001_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Number of Members enrolled in this plan in (H0271 - 029): 31,066 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Learn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 plan for New York. Check eligibility, explore benefits, and enroll today.Medical Plans. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc.License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc ...Number of Members enrolled in this plan in (H0271 - 029): 31,066 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... Thermal Conductivity Btu/ sq ft/ ft hr/ °F at 68°F. 17. Coefficient of Thermal Expansion 68-572 10 to -6 power per °F (68 – 572°F) 9. Specific Heat Capacity Btu/ lb /°F at 68°F. 0.09. Modulus of Elasticity in Tension ksi. 22000. Modulus of Rigidity ksi. H0271 - 060 - 2 Click to see other plans. Member Services: 1-800-514-4912 TTY users 711. — Enrollment Options —. Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete Choice (PPO D-SNP) benefit details. Y0066_SB_H0271_060_001_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage.H0271-060-001 CMS Rating 4 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...UnitedHealthcare Dual Complete Choice (PPO D-SNP) 4 out of 5 stars* for plan year 2023. UnitedHealthcare Dual Complete Choice (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare.Call us: Call UnitedHealthcare at 1-877-596-3258 / TTY 711, 8 a.m. to 8 p.m. 7 days a week. 1 $0 cost-share for in-network dental care, specified services only. If your plan offers out-of-network dental coverage and you see an out-of-network dentist you might be billed more, even for services listed as $0 copay.o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino UnitedHealthcare Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium.The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage. Jan 1, 2023 · Y0066_SB_H0271_013_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... UnitedHealthcare offers UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Lookup Tools plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. H0271-060-001 CMS Rating 4 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...Number of Members enrolled in this plan in (H0271 - 029): 31,066 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... UnitedHealthcare - H0271 En el año 2023, UnitedHealthcare - H0271 recibió las siguientes Calificaciones con Estrellas de Medicare: Calificación General por Estrellas: 4 estrellas Calificación de los Servicios de Salud: 3.5 estrellas Calificación de los Servicios de Medicamentos: 3 estrellasJan 1, 2023 · Y0066_SB_H0271_045_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP Neither Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung,Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond countiesJan 1, 2023 · h0271-029-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. h0271 023 014 ct in me 020 028 mi 029 030 mt 016 sc 037 sd 038 ut 013 wv 042 wy 039 024 h0321 arizona physicians ipa, inc. az h0423 metroplus health plan, inc. h0432 009 h0439 cigna healthcare of georgia, inc. h0473 humana insurance company of kentucky h0482 centene venture company michigan h0524 kaiser foundation hp, inc. ca h0544 blue cross ...See full list on uhcprovider.com 2023 UnitedHealthcare (H0271) Star Rating Details; UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271-060-1) Benefits & Contact Info The UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271-060-1) in Putnam, NY: CMS MA Region 3 which includes: NY: Star Rating Category & Measures: 2023: 2022: Overall Star Rating: 4: 4 H0271 027 * 4. Christian. UnitedHealthcare; UnitedHealthcare Chronic Complete Assure (PPO C-SNP) Local PPO Chronic or Disabling Condition $ 9.80 $ 505.00 No; DS H0271; Y0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Plan ID: H0271-060-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ...Plan ID: H0271-060-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ...H0271-060: Download: UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) 2023: R5342-001: Download: UnitedHealthcare Medicare Advantage Choice Plan 4 ...Learn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 plan for New York. Check eligibility, explore benefits, and enroll today. o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femeninoh0271-060-002 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-002 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.2023 New York UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0271-060-001 Subject: UnitedHealthcare Community Plan of New York manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230220173758ZJan 1, 2023 · h0271-029-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023.UnitedHealthcare offers UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Lookup Tools plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. h0271-029-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.Plan ID: H0271-060-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ...Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung,UnitedHealthcare Dual Complete® Choice (PPO D-SNP) dummy spacing Benefits In-Network Out-of-Network Inpatient Hospital Care2 $0 copay - $1,556 copay per stay 40% coinsurance per2023 UnitedHealthcare (H0271) Star Rating Details; UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271-060-1) Benefits & Contact Info The UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271-060-1) in Putnam, NY: CMS MA Region 3 which includes: NY: Star Rating Category & Measures: 2023: 2022: Overall Star Rating: 4: 4 Y0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageResumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queo UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino Sep 1, 2023 · What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 2 available in Select Counties Downstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023.Jan 1, 2023 · Y0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... Y0066_EOC_H0271_060_001_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002 Subject UnitedHealthcare Dual Complete additional benefit overview for health care professionals. h0271-043-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.CSNY23PP0049826_000 Página 1 de 8 Solicitud de Inscripción 2023 o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul)This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023.UnitedHealthcare Dual Complete® Choice (PPO D-SNP) dummy spacing Benefits In-Network Out-of-Network Inpatient Hospital Care2 $0 copay - $1,556 copay per stay 40% coinsurance perUnitedHealthcare Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium. Y0066_SB_H0271_060_002_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... Call us: Call UnitedHealthcare at 1-877-596-3258 / TTY 711, 8 a.m. to 8 p.m. 7 days a week. 1 $0 cost-share for in-network dental care, specified services only. If your plan offers out-of-network dental coverage and you see an out-of-network dentist you might be billed more, even for services listed as $0 copay.Number of Members enrolled in this plan in (H0271 - 060): 6,780 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Y0066_SB_H0271_050_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educatedY0066_SB_H0271_013_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Y0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung,Jan 1, 2023 · Y0066_SB_H0271_050_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... Monday – Friday 8 a.m. – 6 p.m. EST 1-888-617-8979 TTY 711. To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.Call (518) 346-2115 for Medicare Advantage, Supplement & Part D Plans in NY MA NJ or FLJan 1, 2023 · Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond counties H0271-060-001 NYMCNYDSNP5P NYMCNYDSNP5F UnitedHealthcare Dual Complete® Choice (PPO DSNP) Bronx, Kings, Nassau, New York, Queens, Richmond H0271-060-002 NYMCNYDSNP6PCSNY23PP0049825_000 Página 1 de 8 Solicitud de Inscripción 2023 o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul)
H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP Neither. Leah
Jan 1, 2023 · Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... Y0066_EOC_H0271_023_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverageo UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberY0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...UnitedHealthcare Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium.Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined. Number of Members enrolled in this plan in (H0271 - 029): 31,066 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...2023 New York UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0271-060-001 Subject: UnitedHealthcare Community Plan of New York manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230220173758Z2023 New York UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0271-060-001 Subject: UnitedHealthcare Community Plan of New York manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230220173758Z What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants.Y0066_SB_H0271_013_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Plan ID: H0271-060-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ... 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-013-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-002Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...H0271 027 * 4. Christian. UnitedHealthcare; UnitedHealthcare Chronic Complete Assure (PPO C-SNP) Local PPO Chronic or Disabling Condition $ 9.80 $ 505.00 No; DS H0271; o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number .