SOCIAL SECURITY ADMINISTRATION
Form SSA-1020-OCR-SM (01-2026)
Form Approved
OMB No. 0960-0696
Application for Extra Help with Medicare Prescription Drug Plan Costs
Use this form to apply for the low-income subsidy under the Medicare Part D program. Answer every question that applies to you.
filled by DearBill (tap a value's chip on the case screen for its source)
awaiting an answer
Paper applications are mailed to: Social Security Administration, Wilkes-Barre Direct
Operations Center, P.O. Box 1020, Wilkes-Barre, PA 18767-9910. In this demo the
submission channel is SIMULATED — nothing is filed.