The following list contains the sequencing of captions and paragraphs for BRI Income-Related Monthly Adjustment Amount (IRMAA) notices. An “R” indicates a required paragraph, while an “O” indicates an optional caption or paragraph that is placed in the notice and is dependent upon business rules. Spanish language notices will use the same sequencing.

Headers: These are all required

SSAH16 Displays the BNC + BIC at the top of each notice after the first page

MESH03 Displays the heading "Social Security Administration" at the top of each notice

SSAH05 Displayes the heading that indicates type of notice is "Important Information"

HDR030 Displays the notice date and the BNC number

SSAH32 Displays the payment legend and address data for IRMAA notices

SNO002 O

SNO0004 0

Introductory (no caption)

MIR028 O Displayed if there is a COLA increase

MIR127 O Displayed if there is no COLA increase

MIR220 R

Caption English: MIRC06 – How Much You Will Get?

Spanish: MIRC06 Cuanto *F1 recibira

MIR221 R

MIR031 O

MIR032 O

MIR208 O

MIR131 O

MIR222 R

Caption English: MIRC19 – How We Figured Your IRMAA

Spanish: MIRC19 - Cómo calculamos las cantidades del IRMAA

MIR047 R

MIR020 R

MIR090 R

Caption English: MIRC20 – Some Special Situations That May Apply to You

Spanish: MIRC20 - Salvedades a la regla que posiblemente apliquen en su caso

MIR046 O

MIR047 R

MIR048 R

Caption English: MIRC07 – If Your Income Has Gone Down

Spanish: MIRC07 - Si sus ingresos han disminuido

MIR054 R

Caption English: MIRC39 - Other Information About IRMAA

Spanish: MIRC39 Otra información sobre IRMAA

MIR130 R

MIR131 O

MIR134 R

Caption English: MIRC09 – If You Disagree With Our Decision

Spanish: Si no está de acuerdo con nuestra decisión

MIR091 R

Caption English: MIRC21 - If You Want To Appeal This Decision

Spanish: Si desea apelar esta decisión

ALS095 R

Caption English REPC01 - If You Want Help With Your Appeal

Spanish Caption REPC01 - Si quiere ayuda con su apelación

REP002 R

Caption English MIRC34 - Working and Getting Social Security At The Same Time

Spanish Caption MIRC34 - Trabajando y recibiendo Seguro Social al mismo tiempo

MIR212 O

Caption English INFC68 - If You Receive A Pension From Employment Not Covered By Social Security

Spanish Caption INFC68 - Si *F1 una pensión de empleo no cubierta por el Seguro Social

INF207 R

English Text Caption MIRC38 - Information About Your Medicare Coverage

Spanish Text Información sobre la cobertura de Medicare

MIR223 R

English Text Caption MIRC31 - my Social Security Online Services.

Spanish Text Los servicios por internet de la cuenta «my Social Security»

MIR207 R

English Text Caption - MIRC32 - Life Changes May Affect Your Benefits

Spanish Text Los cambios de vida pueden afectar sus beneficios

MIR210 R

MIS159 R

INFC57 R

INF143 R

REFC07 R

English Text: Caption – REFC07 - If You Have Questions

Spanish Text: Caption – REFC07 - Si tiene preguntas

MIR217 R

MIR218 R

SSAS30 R This is the generic Social Security Administration signature for all IRMAA notices.

English Text: Social Security Administration

Spanish Text: Administración del Segura Social

The following list contains the sequencing of captions and paragraphs for non-BRI Annual IRMAA notices. The non-BRI group contains beneficiaries for whom the Railroad Retirement Board has jurisdiction, retired Civil Service Annuitants whose Medicare Part B premiums are withheld by the Office of Personnel Management, and those who remit their premiums directly to the Centers for Medicare and Medicaid. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph. Spanish language notices will use the same sequencing.

SSAH16 Displays the BNC + BIC at the top of each notice after the first page.

MESH03 Displays the heading “Social Security Administration” at the top of each Notice.

SSAH05 Displays the heading that indicates type of notice is "Important Information."

HDR030 Displays the notice date and the BNC number

SSAH32 Displays the Payment Legend and Address data for the IRMAA notices.

SNO002 O

SNO004 O

Introductory Paragraph

MIR029 R

MIR130 R

MIR144 R

MIR005 O

MIR145 R

MIR037 O

MIR146 O

MIR224 O

MIR133 O

Caption MIRC19

English Text: How We Figured Your IRMAA

Spanish Text: Cómo calculamos las cantidades del IRMAA

MIR047 R

MIR020 R

MIR090 R

Caption MIRC20

English Text: Some Special Situations That May Apply To You

Spanish Text: Salvedades a la regla que posiblemente apliquen en su caso

MIR046 O

MIR048 R

Caption MIRC07 – If Your Income Has Gone Down

English Text: If Your Income Has Gone Down

Spanish Text: Si sus ingresos han disminuido

MIR054 R

Caption MIRC39 – Other Information About IRMAA

MIR134 O

Caption MIRC09 - English Text: If You Disagree With Our Decision

Spanish Text: Si no está de acuerdo con nuestra decisión

MIR091

Caption MIRC21 English Text: If You Want To Appeal This Decision

Spanish Text: Si desea apelar esta decisión

ALS095

Caption REPC01 - English Text: If You Want Help With Your Appeal

Spanish Text: Si quiere ayuda con su apelación

REP002

English Text: Caption MIRC38 - Information About Your Medicare Coverage

Spanish Text: Información sobre la cobertura de Medicare *F1

MIR223

English Text: Caption MIRC31 - my Social Security Online Services

Spanish Text: Los servicios por internet de la cuenta «my Social Security»

MIR207

MIS159

Caption INFC57

English Text: Help Prevent Identity Theft

Spanish Text: Ayude a evitar el robo de identidad

INF143

Caption REFC07 English Text: If You Have Questions

Spanish Text: Si tiene preguntas

REF095

REF101