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"
Proof of citizenship
Social Security number
|Documents that are accepted as proof of the information needed. Examples:
State driver’s license
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."