The following list contains the sequencing of captions and paragraphs for IRMAA New
Initial Determination Notices for T2 beneficiaries. An “R” indicates a required paragraph,
while an “O” indicates an optional paragraph.
· Introductory (no caption)
MIR040 R
MIR004 R
MIR065 R
MIR016 O
MIR006 O
MIR007 R
MIR017 O
MIR008 R
-
•
MIRC02 – Another Letter
MIR010 R
-
•
MIRCO4 – How We Decided Your Income-Related Premium Amount
MIR080 O
MIR081 O
MIR030 O
MIR019 R
MIR020 R
MIR114 O
-
•
MIRC05 – If The Information You Gave Us Changes
MIR035 O
-
•
MIRC03 – If You Have Other Information About Your Income
MIR027 O
MIR036 O
MIR024 O
MIR088 O
-
•
ALSC19 – If You Disagree With This Decision
ALS162 R
-
•
REPC01 – If You Want Help With Your Appeal
REP031 R
-
•
REFC01 – If You Have Any Questions
REF103 O
REF104 O
REF106 O