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