TN 5 (02-15)

HI 01140.005 The Reconsideration Process for the Income-Related Monthly Adjustment Amount

A. Policy for the IRMAA reconsiderations process

As explained in HI 01101.010, a beneficiary's Income-Related Monthly Adjustment Amount (IRMAA) is determined based on the:

  • beneficiary's MAGI, which is the total of the Adjusted Gross Income (AGI) and certain tax exempt interest income (TEI), and

  • filing status on the beneficiary's Federal Tax Return.

SSA uses the IRMAA sliding scale to determine the level of IRMAA that will apply, see HI 01101.020. If the beneficiary disagrees with the accuracy of the determination made based on the MAGI information provided by IRS, he may file a reconsideration request. However, in most situations, a new initial determination can provide the beneficiary with the same results as an appeal (i.e. a change in the IRMAA), so an appeal is not necessary.

For when a beneficiary may request a new initial determination, see HI 01120.001. A beneficiary may file a reconsideration request and a new initial determination request at the same time. For determining whether the beneficiary has good cause for late filing of the appeal, see GN 03101.020, if a beneficiary is outside of the appeals period.

NOTE: For IRMAA purposes, SSA will find good cause applies if:

  • a beneficiary requested a new initial determination instead of an appeal based on our explanation,

  • the new initial determination is denied or dismissed,

  • the individual is now outside the appeals period, and

  • the beneficiary wants to file an appeal.

B. How to process a reconsideration request when a new initial determination may apply

Follow the instructions in HI 01101.050C to determine if a beneficiary is requesting a new initial determination. If the beneficiary qualifies for a new initial determination and agrees to file a request for a new initial determination instead of a reconsideration, follow the instructions listed in HI 01120.005 through HI 01120.040.

NOTE: PCs are responsible for processing IRMAA reconsideration requests received directly from beneficiaries and requests transferred from the FO to the PC. When a PC receives a case from the FO, the PC determines if a manual action is required due to a processing limitation. If the FO has not taken action and it appears the transfer was in error, process the request and contact the FO to direct them to the instructions contained in HI 01140.005. Use direct contact procedures for all development requests following the procedures in GN 01070.300 through GN 01070.330.

Always advise the beneficiary of the options to file:

  • a new initial determination request,

  • a reconsideration request, or

  • both.

NOTES:

  • A predetermination notice (see HI 01101.035D) is not a notice of determination and does not contain appeal rights. It is a notice of planned action. If a beneficiary insists on filing an appeal based on a predetermination notice follow the instructions listed in HI 01140.005C through HI 01140.005E.

  • SSA must always accept a request for an appeal if the beneficiary wishes to file an appeal. SSA cannot discourage an individual from filing an appeal.

  • Once received, enter the reconsideration request into the IRMAA Appeals Tracking System on the intranet.

Recording an IRMAA reconsideration request is a three-step process:

  1. Initiate the appeal by annotating the IRMAA Appeals Tracking System, then

  2. Input the request on the IRMAA PCOM screens where a determination will be processed and effectuated, then

  3. Post the decision to the IRMAA Appeals Tracking System. (See HI 01140.005C through HI 01140.005E.)

For evidence requirements for individuals appealing based on a life changing event, amended, corrected or more recent tax return information or a living arrangement change with a tax filing status of married filing separately, see HI 01120.001 through HI 01120.060. After completing all screens record evidence submitted on the EVID screen in the Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).

C. Initiating the IRMAA reconsideration process

All appeal requests must be input in the IRMAA Appeals Tracking System. Some examples of appeal requests are the:

  • beneficiary disagrees with the IRMAA determination because he or she does not agree with the constitutionality of imposing IRMAA and provides no new information.

  • beneficiary insists on filing an appeal and provides no new or additional information or the information provided does not result in a change in the IRMAA level.

  • beneficiary insists on filing a request for reconsideration and provides information that would qualify him or her for a new initial determination.

  • information provided confirms the information provided by the IRS is correct but the system is applying the wrong IRMAA level or computing the MAGI incorrectly.

  • beneficiary files a reconsideration request outside of the appeal period and there is no good cause for late filing.

  • beneficiary insists on filing an appeal based on an event other than one listed in HI 01120.001E.

  • beneficiary insists on filing a reconsideration based on IRS information being incorrect and has no proof of the error, or

  • beneficiary insists on filing a reconsideration based on information received about a proposed action in a predetermination notice.

If…

then…

the beneficiary requests an appeal of the IRMAA determination;

access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s own SSN (BOAN - do not enter the claim number), click on Search.

  • Click the YES radio button to enter a new appeal and then click continue.

  • Enter your unit code, the beneficiary’s first name, middle initial and last name. Then click continue.

  • Date of Determination – Enter the date of the determination. This is always the date of a notice. This should be the date of the Initial Notice to Impose IRMAA or the date of the new initial determination.

  • Date Appeal Filed – Enter the date the beneficiary filed the request for reconsideration.

  • Select Event – Select the type of event the beneficiary is appealing. They can appeal their Initial Determination, an LCE, More Recent Tax Information or Non-Qualifying Event for an event other than one listed in HI 01120.001E.

  • Date of the Event – Enter the date of the event being appealed.

  • Beneficiary Report Date – Enter the date the beneficiary reported the event being appealed – this may be the same date as the Date Appeal Filed if there was not a separate event reported that is being appealed.

  • Reason For Appeal - Select the reason the beneficiary is filing the appeal. For most individuals who disagree with the IRMAA determination and not with the law or the data IRS provided, the reason will be Disagrees with Level. Otherwise, select the specific reason for the appeal such as Disagrees With Law for a beneficiary who does not agree with the constitutionality of imposing IRMAA.

  • Select Level of Appeal - Select Reconsideration.

  • Rep or Attorney - Select Yes if the beneficiary has a representative or attorney.

  • Good Cause - If good cause is involved and the beneficiary has good cause for late filing of the appeal select “Yes”.

  • Remarks - This is free format to add anything the beneficiary may have included on a paper SSA-561-U2 submitted. If good cause applies, you must document the explanation of the beneficiary's reason for good cause in Remarks.

  • Click Continue.

  • On the Attestation of Penalty of Perjury Screen - Record the beneficiary's response to the Attestation Statement. If the beneficiary does not attest, the reconsideration will not be able to be processed. If the beneficiary sent in a signed paper SSA-561-U2 (Request for Reconsideration), answer “YES” to the attestation question.

  • Click on Save and Exit. This will save the action in the system.

  • For additional assistance on how to complete the fields see the Screen Help information located on each page.

  • Effectuate the decision using the IRMAA PCOM screens as explained in HI 01140.005D in this section.

D. Effectuating a reconsideration determination using the IRMAA PCOM screens

All reconsideration requests are processed by someone other than the person who made the original decision. When you receive a reconsideration request, evaluate all the information received as well as the information already in the system in order to make the correct inputs for a reconsideration determination.

NOTE: All evidence received with an appeal must be input into the Shared Processes EVID screens. For evidence requirements for individuals appealing based on a life changing event, amended, corrected or more recent tax return information or a living arrangement change with a tax filing status of married filing separately, see HI 01120.001 through HI 01120.060. After completing all the required screens, record the evidence submitted on the EVID screen in the Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).

Once you annotate the IRMAA Appeals Tracking System with the reconsideration request, you effectuate the decision using the IRMAA PCOM screens. Follow the chart below to determine how to complete the required reconsideration determination information on the IRMAA PCOM screens. Once you effectuate the determination on the IRMAA PCOM screens, you must post the determination on the IRMAA Appeals Tracking System.

NOTE: When a payee is involved, annotate the Remarks field on the IRMA (Tax Information) screen with a statement showing the representative payee's information as follows: representative payee name for beneficiary's name. Check the MBR to verify this is the correct representative payee for the beneficiary.

If…

then…

the beneficiary insists on filing a reconsideration based on information received about a proposed action in a predetermination notice;

  • Access the Online Retrieval System (ORS) to verify the date of the notice.

  • Create an MDW with a 21-day tickle from the date of the notice.

  • Once the tickle matures, process the appeal. (Follow the appropriate instructions below that apply to the request for reconsideration.)

after reviewing the information received, you determine the beneficiary agrees with how SSA computed their MAGI and/or how SSA used the Sliding Scale Tables to apply IRMAA but disagrees with the constitutionality of imposing IRMAA;

Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017).

On the IRMN screen:

  • Enter the Beneficiary’s Own SSN(BOAN).

  • Select “2” Tax information in the“Desired Function” field.

  • Input the Tax Year currently used to determine the IRMAA.

  • Enter “Y” in the “Appeal Involved” field.

  • Press Enter.

On the IRMAA Appeals Determination (IRAP) Screen:

  • Select “1” Reconsideration for the level of appeal.

  • For Recon Dismissal enter “N”.

  • Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.

  • In “Date of Appeal Determination” enter the date of the determination (usually the current date).

  • Enter the premium year the beneficiary is appealing.

  • In the Remarks field, enter “Disagrees with the constitutionality of the law.”

  • Press Enter.

On the IRMA screen:

  • Input the same exact AGI and TEI used to determine the IRMAA.

  • Select “Tax Return” for source code.

  • Press Enter.

The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the appeal determination based on the information entered. In this case the determination should be “Affirmation.”

  • Enter a “Y” in the Process All Transactions field. If you enter an “N”, you will cancel all transactions associated with this input.

  • Enter the reconsideration determination into the IRMAA Appeals Tracking System following the instructions in HI 01140.005E in this section.

the beneficiary insists on filing an appeal, and after reviewing the information received, you determine the beneficiary does not disagree with how SSA computed his MAGI and how SSA used the Sliding Scale Tables to apply IRMAA and provides no new information or the new information does not make a change;

Access the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017).

On the IRMN screen:

  • Enter the Beneficiary’s Own SSN (BOAN).

  • Select “2” Tax information in the “Desired Function” field.

  • Input the Tax Year currently used to determine the IRMAA.

  • Enter “Y” in the “Appeal Involved” field.

  • Press Enter.

On the IRMAA Appeals Determination (IRAP) Screen

  • Select “1” Reconsideration for the level of appeal.

  • Enter “N” for Recon Dismissal.

  • Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.

  • Enter the date of the determination (this will usually be the current date) in the “Date of Appeal Determination” field.

  • Enter the premium year the beneficiary is appealing.

  • In the Remarks field, enter “No change and no new information provided.”

  • Press Enter.

On the IRMA screen

  • If the beneficiary does not provide new information, input the same exact AGI and TEI that we are currently using to determine the IRMAA. Select source code of “Tax Return”.

  • If the information provided makes no change, input the AGI and TEI alleged by the beneficiary. Select source code of “Estimate”.

  • Select Proof of “proven”.

  • Press Enter.

The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the appeal determination based on the information entered. In this case the determination should be “Affirmation.”

  • Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all transactions associated with this input.

  • Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E. in this section.

a beneficiary insists on filing a reconsideration based on an event other than one listed in HI 01120.001E.

Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017).

On the IRMN screen:

  • Enter the Beneficiary’s Own SSN (BOAN)

  • Select “1” LCE for the “Desired Function” field.

  • Enter “Y” in the “Appeal Involved” field.

  • Press Enter.

On the IRMAA Appeals Determination (IRAP) Screen:

  • Select “1” Reconsideration for the level of appeal.

  • Enter “N” for Recon Dismissal field.

  • Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.

  • Enter the date of the determination (usually the current date) in the “Date of Appeal Determination” field.

  • Enter the premium year the beneficiary is appealing

  • In the Remarks field enter “Non-qualifying event.”

  • Press Enter.

On the IRLC screen:

  • Select “8” Non-Qualifying Event” for the LCE Field.

  • Enter the date of the non-qualifying event (NQE) in the “Date of LCE” field.

  • In the Remarks field, describe the NQE that the beneficiary is claiming (sale of property).

  • Press Enter.

On the IRMA screen:

  • Input the AGI and TEI alleged by the beneficiary for the tax year the alleged reduction in MAGI took place.

  • Select “Estimate” for source code, if the tax year is a more recent tax year than the year currently used. If the beneficiary provides no new information, input the same exact AGI and TEI currently used to determine the IRMAA. Select “Tax Return” as the source code.

  • Show the estimate as Proven.

  • Press Enter.

The IRRE Screen will display the current and recalculated IRMAA data. The "New Determination Results" field will provide the appeal determination based on the information entered. In this case, the determination should be "Affirmation."

  • Enter a "Y" in the Process All Transactions field. Entering an "N" will cancel all transactions associated with this input.

  • Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E in this section.

after reviewing the information received you determine the beneficiary qualifies for a new initial determination but insists on filing a reconsideration;

Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017).

On the IRMN screen:

  • Select the appropriate option based on the information provided for the “Desired Function” field. See HI 01120.001E.

  • Enter “Y” in the “Appeal Involved” field.

  • Press Enter.

On the IRMAA Appeals Determination (IRAP) Screen:

  • Select “1” Reconsideration for the level of appeal.

  • Enter “N” for Recon Dismissal.

  • Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.

  • Enter the determination dates (usually the current date) in the “Date of Appeal Determination” field.

  • Enter the premium year the beneficiary is appealing

  • In the Remarks field enter, “Information provided qualifies for new initial determination, insists on appeal”.

  • Press Enter.

NOTE: Complete all other screens as if you are processing a request for a new initial determination. See MSOM T2PE 008.001 through MSOM T2PE 008.013.

The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the appeal determination based on the information entered.

  • Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all transactions associated with this input.

  • Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E in this section.

after reviewing the information received, you determine SSA did not compute the beneficiary's MAGI correctly or did not apply the proper level of the Sliding Scale Tables to determine IRMAA;

NOTE: This only applies if the reviewed information is the same information SSA used to make the IRMAA determination.

Access the IRMAA calculator. (See MSOM T2PE 008.013.)

On the IRMAA Menu (IRSU), select Function “3” Calculator.

On the IRCA Screen:

  • Re-input the same information currently used in the IRMAA determination to determine if this is a systems error. (See MSOM T2PE 008.013.)

  • If you receive the correct computation; re-input the information on the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017.)

  • The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the appeal determination based on the information entered.

  • If you receive the same incorrect computation; contact your Regional Office Coordinator to process the appeal using the “Manual IRMAA Adjustment” process.

NOTE: The Regional Office Coordinator will provide the referring technician with the disposition so it can be posted to the IRMAA Appeals Tracking System as instructed in HI 01140.005E in this section.

after reviewing the information received, you determine the beneficiary agrees with how SSA computed his MAGI and how SSA used the Sliding Scale Tables to apply IRMAA but believes that the information SSA received from IRS is not correct and has not provided documentation to support the error but insists on filing a reconsideration;

Process a “Dismissal” decision.

Access the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017).

On the IRMN screen:

  • Enter the Beneficiary’s Own SSN (BOAN).

  • Select “2” Tax information in the “Desired Function” field.

  • Input the Tax Year currently used to determine the IRMAA.

  • Enter “Y” in the “Appeal Involved” field.

  • Press Enter.

On the IRMAA Appeals Determination (IRAP) Screen:

  • Select “1” Reconsideration for the level of appeal.

  • Enter “Y” for Recon Dismissal.

  • Leave Good Cause blank if no good cause is involved. Show “Y” if good cause is involved and established, or “N” if good cause is involved but not established.

  • Enter the determination date (l usually the current date) in “Date of Appeal Determination”.

  • Enter the premium year the beneficiary is appealing.

  • In the Remarks field enter “Does not agree with IRS Information and no documentation to support an error.”

  • Press Enter.

On the IRMA screen:

  • Input the same exact AGI and TEI currently used to determine the IRMAA.

  • Select “4”, IRS Tax Correction Data for the source code.

  • Select “2”, Not Proven for proof .

  • Press Enter.

The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the appeal determination based on the information entered. In this case the determination should be a “Dismissal.”

  • Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all transactions associated with this input.

  • Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E.

  • Advise the beneficiary to contact IRS at 1-800-829-1040 to have the information corrected.

    Inform the beneficiary to recontact SSA if he receives a letter from IRS confirming the error and the correct information.

The reconsideration request received is outside of the appeal period and no good cause for late filing was established per GN 03101.020.

Process a “Dismissal” decision.

Access the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017).

On the IRMN screen:

  • Enter the Beneficiary’s own SSN (BOAN).

  • Select the appropriate option based on the information provided in the “Desired Function” field. See HI 01120.001E.

  • Enter “Y” in the “Appeal Involved” field.

  • Press Enter.

On the IRMAA Appeals Determination (IRAP) Screen:

  • Select “1” Reconsideration for the level of appeal.

  • For Recon Dismissal enter “Y”.

  • For Good Cause show “N”.

  • In “Date of Appeal Determination” enter the date the determination is made (this will usually be the current date).

  • Enter the premium year to which this appeal applies.

  • In the Remarks enter “late filing-no good cause established.”

  • On the IRMA screen enter the information regarding MAGI and Tax filing status alleged by the beneficiary for the more recent tax year.

  • The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the appeal determination based on the information entered. In this case the determination should be a “Dismissal.”

  • Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all transactions associated with this.

  • Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E in this section.

NOTE: The system will automatically release all notices.

E. Posting an IRMAA reconsideration determination in the IRMAA Appeals Tracking System

If…

then…

the beneficiary disagrees with the IRMAA determination because he does not agree with the constitutionality of imposing IRMAA and provides no new information;

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s own SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Enter Disposition Date – Enter the date of the reconsideration determination. In most cases, this will be the current date.

  • Statement of Issues – Select Beneficiary disagrees with the law.

  • Statement of Fact – Enter the IRMAA Level and other information being used for the premium year the beneficiary is appealing.

  • Proof Submitted – Answer “Yes” if the beneficiary provided any additional documentation.

    NOTE: Enter all documentation provided by the beneficiary on the EVID screen in Shared Processes. (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.)

  • Other – If you need to provide more information select other. Explain the additional information in Remarks.

  • Remarks – Remarks are mandatory. You must enter any beneficiary alleged MAGI or Tax filing information related to the request.

  • Finding of Fact – Select all that apply. If good cause was an issue, select other.

  • Remarks – Explain that the beneficiary disagrees with the constitutionality of the imposition of IRMAA. If good cause was an issue, document your good cause determination.

  • Disposition – Select Affirmation (this is the disposition that is generated on the IRRE PCOM Screen from the process in HI 01140.005D in this section.)

  • Law/Regulation – Select Authority to Impose IRMAA – Reg #418.1101.

  • Click Submit to Appeal.

the beneficiary insists on filing an appeal and provides no new or additional information or the information provided does not result in a change in the IRMAA level;

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s OWN SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Enter Disposition Date – Enter the date of the reconsideration determination. In most cases, this will be the current date; however, it can be a prior date if the determination was made previously.

  • Statement of Issues – Select all that apply. These selections will depend on the Event being appealed and the reason for the appeal.

  • Statement of Fact – Enter the IRMAA Level and other information currently being used for the premium year being appealed.

  • Proof Submitted – Answer “Yes” if the beneficiary provided any additional documentation.

    NOTE: Enter all documentation provided by the beneficiary on the EVID screen in Shared Processes. (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.)

  • Other – If you need to provide more information select other. Explain the additional information in Remarks.

  • Remarks – Remarks are mandatory. You must enter any beneficiary alleged MAGI or Tax filing information related to the request.

  • Finding of Fact – Select all that apply. If good cause was an issue, select other.

  • Remarks – Provide any additional information relevant to the reconsideration determination. If good cause was an issue, document your good cause determination.

  • Disposition – Select Affirmation (this will be generated on the IRRE PCOM Screen from the process in HI 01140.005D in this section).

  • Law/Regulation – Select all that apply. These selections will depend on the Event being appealed and reason for the appeal.

  • Click Submit to Appeal.

the beneficiary insists on filing an appeal based on an event other than one listed in HI 01120.001E;

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s Own SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Enter Disposition Date – Enter the date of the reconsideration determination. In most cases, this will be the current date; however it can be a prior date if the determination was made previously.

  • Statement of Issues – Select Beneficiary disagrees with the level of IRMAA and Other.

  • Remarks - Enter the information regarding the Non-Qualifying Event that the beneficiary is reporting.

  • Statement of Fact – Enter the IRMAA Level and other information currently being used for the premium year being appealed.

  • Proof Submitted – Answer Yes if the beneficiary provided any additional documentation. All documentation provided by the beneficiary must be entered into the Shared Evidence Screens.

  • Other – If you need to provide more information select Other. Explain the additional information in Remarks.

  • Remarks – Remarks are mandatory. You must enter any beneficiary alleged MAGI or Tax filing information related to the request.

  • Finding of Fact – Select Other.

  • Remarks – Explain that the beneficiary alleges having an event that does not qualify as a LCE and does not support the use of a More Recent Tax Year. If good cause was an issue, document your good cause determination.

  • Disposition – Select Affirmation (this is the disposition that is generated on the IRRE PCOM Screen from the process in HI 01140.005D in this section)

  • Law/Regulation – Select LCE – Reg #418.1201 and Calculations of IRMAA – Reg #418.1120.

  • Click Submit to Appeal.

the beneficiary insists on filing a reconsideration and provides information that would qualify him for a new initial determination;

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s OWN SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Enter Disposition Date – Enter the date the reconsideration determination was made. In most cases this will be the current date; however it can be a prior date if the determination was made previously.

  • Statement of Issues – Select all that apply. These selections will depend on the Event being appealed and the reason for the appeal.

  • Statement of Fact – Enter the IRMAA Level and other information currently being used for the premium year being appealed.

  • Proof Submitted – Answer “Yes” if the beneficiary provided any additional documentation.

    NOTE: All documentation provided by the beneficiary must be entered on the EVID screen in Shared Processes. (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.)

  • Remarks – Remarks are mandatory. You must enter any beneficiary alleged MAGI or Tax filing information related to the request.

  • Select Other – In the Remarks explain the MAGI allegations and filing status alleged by the beneficiary.

  • Finding of Fact – Select all that apply. These selections will depend on the Event being appealed, reason for the appeal and documentation provided. If good cause was an issue, select other and document your good cause determination in the Remarks.

  • Disposition – Select either Fully Favorable Reversal or Partially Favorable Reversal (this is the disposition that is generated on the IRRE PCOM Screen from the process in HI 01140.005D in this section.)

  • Law/Regulation –Select all that apply. These selections will depend on the Event being appealed and reason for the appeal.

  • Click Submit to Appeal.

The information provided confirms the information provided by IRS is correct but the system is applying the wrong IRMAA level or computing the MAGI incorrectly.

NOTE: Once the Manual Action has been completed by the Regional Office Coordinator the referring field office or processing center posts the disposition.

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s OWN SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Enter Disposition Date – Enter the date of the reconsideration determination. In most cases, this will be the current date; however it can be a prior date if the determination was made previously.

  • Statement of Issues – Select Beneficiary disagrees with the level of the IRMAA being imposed.

  • Statement of Fact – Enter the IRMAA Level and other information currently being used for the premium year being appealed.

  • Proof Submitted – Answer “Yes” if the beneficiary provided any additional documentation.

    NOTE: Enter all documentation provided by the beneficiary on the EVID screen in Shared Processes. (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.)

  • Select Other l.

  • Remarks– Remarks are mandatory. The Remarks will explain that there is an error with the system calculating the correct IRMAA level. You must enter any beneficiary alleged MAGI or tax filing information related to the request.

  • Finding of Fact – Select Other.

  • Remarks – Explain that the system is not computing the correct level of IRMAA for the beneficiary. If good cause was an issue, document your good cause determination.

  • Disposition – Select either Fully Favorable Reversal or Partially Favorable Reversal (this is the disposition that is generated on the IRRE PCOM Screen from the process in HI 01140.005D in this section).

  • Law/Regulation – Select Calculations of IRMAA – Reg #418.1120.

  • Click Submit to Appeal.

The beneficiary insists on filing a reconsideration based on IRS information being incorrect and has no proof of the error.

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/Delete Appeal.

  • Enter the Beneficiary’s OWN SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Statement of Issues – Select Beneficiary requests the use of the Corrected IRS Data.

  • Statement of Fact – Enter the IRMAA Level and other information currently being used for the premium year being appealed.

  • Proof Submitted – The NO is pre-filled and this is correct since the beneficiary does not have proof of the incorrect IRS Data.

  • Remarks – Remarks are mandatory. The Remarks will explain the MAGI allegations and filing status alleged by the beneficiary.

  • Finding of Fact – Select Other

  • Remarks – Explain that the beneficiary is alleging that the data received from IRS is incorrect. However, the beneficiary does not have documentation showing the error and correct information. If good cause was an issue, document your good cause determination.

  • Disposition – Select Dismissal (this is the disposition that is generated on the IRRE PCOM Screen from the process in HI 01140.005D in this section).

  • Law/Regulation – Select Corrected IRS Tax Information – Reg #418.1335.

  • Click Submit to Appeal.

The beneficiary files a reconsideration request outside of the appeal period and there is no good cause for late filing.

Access the IRMAA Appeals Tracking System:

  • Click on Establish/Update/

Delete Appeal.

  • Enter the Beneficiary’s OWN SSN (do not enter the claim number), click on Search.

  • Click on the Select Option next to the pending appeal established per instructions in HI 01140.005C in this section.

  • Click on Enter Recon Determination.

  • Enter Disposition Date – Enter the date of the reconsideration determination. In most cases, this will be the current date; however it can be a prior date if the determination was made previously.

  • Statement of Issues – Select all that apply. These selections will depend on the Event being appealed and the reason for the appeal.

  • Statement of Fact – Enter the IRMAA Level and other information currently being used for the premium year being appealed.

  • Proof Submitted – Answer “Yes” if the beneficiary provided any additional documentation.

    NOTE: Enter all documentation provided by the beneficiary on the EVID screen in Shared Processes. (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.)

  • Remarks – Remarks are mandatory. The Remarks will explain the MAGI allegations and filing status alleged by the beneficiary.

  • Finding of Fact – Select Other and any additional selections that apply. These selections will depend on the Event being appealed, reason for the appeal and documentation provided.

  • Remarks – Explain the situation alleged as a reason for late filing as well as why good cause for late filing was not granted.

  • Disposition – Select Dismissal (this disposition will generate on the IRRE PCOM Screen from the process in HI 01140.005D in this section).

  • Law/Regulation – Select Good Cause - Reg #404.911 and any others that apply. These selections will depend on the Event being appealed and reason for the appeal.

  • Click Submit to Appeal.

F. Processing and posting a reconsideration determination and a new initial determination concurrently

If...

then...

a beneficiary submits an SSA-561-U2 (Request for Reconsideration) and disagrees with the decision based on new information that would qualify him for a new initial determination and makes a request for a new initial determination using the same information as was provided on the SSA-561-U2;

  • Process the reconsideration first using the information provided. See HI 01140.005C through HI 01140.005E in this section.

  • After processing the reconsideration, process the request for a new initial determination using the same information.

  • The new initial determination will result in a “no change” dismissal since there is no change from the result of the reconsideration determination.

a beneficiary requests a new initial determination based on a qualifying event and requests a reconsideration because he does not agree with the constitutionality of imposing IRMAA;

  • Process the request for a new initial determination. See HI 01120.001I to determine what evidence must be submitted and what process to follow.

  • After processing the new initial determination, process an “Affirmation” decision for the reconsideration as described in HI 01140.005C in this section.

NOTE: All appeal determinations must be input in the intranet IRMAA Appeals Tracking System and the IRMAA PCOM system. For guidance on how to process reconsideration determinations, follow HI 01140.005C through HI 01140.005E. in this section.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601140005
HI 01140.005 - The Reconsideration Process for the Income-Related Monthly Adjustment Amount - 02/04/2015
Batch run: 02/04/2015
Rev:02/04/2015