BASIC (11-06)

HI 01190.020 Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) BRI Notices and Annual Non-Title II Notices

A. Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) BRI Notices

The following list contains the sequencing of captions and paragraphs for BRI Income-Related Monthly Adjustment Amount (IRMAA) notices. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph. Spanish language notices will use the same sequencing.

  • Introductory (no caption)

    MIR028 R

  • Caption MIRC06 – How Much Social Security Will I Get?

    MIR031 R

    MIR032 R

    MIR005 R

    MIR033 O

    MIR034 O

    MIR037 R

    MIR038 O

    MIR039 O

    MIR042 O

    MIR043 O

    MIR044 O

    MIR064 O

  • Caption MIRC01 – About Your Medicare Part B Premium

    MIR045 R

    MIR047 R

    MIR019 R

    MIR020 R

    MIR046 O

    MIR048 O

    MIR053 R

    MIR049 O

  • Caption MIRC07 – If Your Income Has Gone Down

    MIR054 R

  • Caption MIRC08 –

    If You Believe The MAGI Information For The Year We Used Is Incorrect

    MIR057 R

  • Caption MIRC09

    If You Disagree With Our Decision About Your Income-Related Monthly Adjustment Amount

    ALS164 R

  • Caption REPC01 If You Want Help With Your Appeal

    REP033 R

  • Caption MIRC11 – Other Medicare Information

    MIR058 R

  • Caption MIRC12 – Other Important Social Security Information

    MIR059 O

    MIR061 O

    MIR062 R

  • Caption MIRC13 – For More Information Or To Contact Us

    REF094 O

    REF102 O

B. Sequencing for non-BRI Annual IRMAA Notices

The following list contains the sequencing of captions and paragraphs for non-BRI Annual IRMAA notices. The non-BRI group contains beneficiaries for whom the Railroad Retirement Board has jurisdiction, retired Civil Service Annuitants whose Medicare Part B premiums are withheld by the Office of Personnel Management, and those who remit their premiums directly to the Centers for Medicare and Medicaid. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph. Spanish language notices will use the same sequencing.

  • Introductory (No caption)

    MIR029 O

    MIR063 O

  • MIRC01 – About Your Medicare Part B Premium

    MIR045 R

    MIR047 R

    MIR019 R

    MIR020 R

    MIR046 O

    MIR048 O

    MIR049 O

  • MIRC07 – If Your Income Has Gone Down

    MIR054 R

  • MIRC08 – If You Believe The MAGI Information For The Year We Used Is Incorrect

    MIR057 R

  • MIRC09 – If You Disagree With Our Decision About Your Income-Related Monthly Adjustment Amount

    ALS164 R

  • REPC01 – If You Want Help With Your Appeal

    REP033 R

  • MIRC13 – For More Information Or To Contact Us

    REF095 O

    REF101 O


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601190020
HI 01190.020 - Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) BRI Notices and Annual Non-Title II Notices - 09/18/2012
Batch run: 09/18/2012
Rev:09/18/2012