Effective Dates: 11/19/2001 - Present Previous | Next

HI 00801.121 FORM RR-80 (Report of Health Insurance Information — SSA Jurisdiction)

See HI 00801.901 for an exhibit of this form. It is a leads form used by RRB to notify CMS and the Social Security Administration that an RR claimant is not eligible for HI-SMI coverage under the RRB but may be eligible for coverage with SSA.

Act, as Amended in 1972—Sec. 1818

1972 Amendments—Sec. 202

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600801121

HI 00801.121 - FORM RR-80 (Report of Health Insurance Information — SSA Jurisdiction) - 11/19/2001
Batch run: 11/19/2001
Rev:11/19/2001

Program Operations Manual System (POMS)

HI 00801.121 FORM RR-80 (Report of Health Insurance Information — SSA Jurisdiction)