HI 01001.384 Memorandum for Premium Arrearages Based on Equitable Relief

TO:Railroad Retirement Board
 Health Insurance Operations
 844 Rush Street
 Chicago, Illinois 60611
FROM:SSA PSC NE MAT AW FL MM QN ODO DIO
SUBJECT:SMI Premium Arrearages Based on Equitable Relief

 

Take the following actions on this case:

 

    RRB claim number                

 

    SSA claim number                

 

    Name                                           

 

Check the appropriate box:

 

□ 1.  Waiver request - Development made by district office

 

□ 2.  Beneficiary in: □ current pay  □ suspense  □  uninsured status

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601001384
HI 01001.384 - Memorandum for Premium Arrearages Based on Equitable Relief - 03/15/1999
Batch run: 01/27/2009
Rev:03/15/1999