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 *
* Client First Name:

* Client Last Name:

Client Social Security #: xxx-xx-xxxx

Client Phone Number: xxx-xxx-xxxx
* Client Date of Birth: MM/DD/YYYY

* Replacement Reason:

* ProgramArea: