Request a Replacement Common Benefit Identification Card (CBIC)

Complete the information below. Once submitted a replacement card will be mailed to you in 4 - 6 business days. Note: If you need a replacement card immediately,
please visit your local Department of Social Services center.

Required fields are marked with an *	Click here if you have moved recently
* Client First Name: * *	* *
* Client Last Name: * *	*
Client Phone Number: XXX-XXX-XXXX *	* *
* Client Date of Birth: MM/DD/YYYY * * *	* * *
* Replacement Reason: *	*
* Program Area: *	*
	*
	*
	*