The following list contains the sequencing of captions and paragraphs for IRMAA New Initial Determination Update 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

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR041                     R

  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

The following list contains the sequencing of captions and paragraphs for IRMAA New Initial Determination Update Notices for Non-T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR040                     R

  MIR018                     R

• •

  COPC01 – Other Information

  MIR013                     O

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR041                     R

  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 Have Any Questions

  REP031                     R

• •

  REFC01 – If You Have Any Questions

  REF093                    O

  REF103                    O

  REF104                    O

  REF106                    O