Exit this survey >> HSS Member Change of Address Health Service System (HSS) members should use this form to notify HSS of a change in their mailing address. HSS respects your privacy. Your contact information is used only by HSS - this information is never shared. 1. Which type of HSS member is requesting an address change? SFCCD employee City & County employee SFUSD employee Retiree Other (please specify) 2. What is the HSS member's NEW home address?Street addresses only. You must call Member Services at (415) 554-1750 if your home address is a post office box. Name: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: 3. What is the HSS member's phone number? HSS may require phone confirmation of this change of address request. Phone Number: 4. What is the HSS member's email address?HSS may require confirmation of this change of address request by email. Email Address: Done >>
