TN 2 (08-08)

HI 01190.025 Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Predetermination Notices

A. Sequencing for IRMAA predetermination notices for T2 beneficiaries

The following list contains the sequencing of captions and paragraphs for IRMAA Predetermination notices for T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

  • Introductory (no caption)

    MIR001                      R

    MIR014                      O

    MIR009                      R

    MIR002                      R

    MIR065                      R

    MIR006                      O

    MIR007                      R

    MIR017                      O

    MIR008                      R

  • Caption MIRC04How We Decided Your Income-Related Premium Amount

    MIR080                      O

    MIR081                      O

    MIR084                      O

    MIR030                      O

    MIR019                      R

    MIR020                      R

    MIR097                      O

  • Caption MIRC03 – If You Have Other Information About Your Income

    MIR021                      O

    MIR027                      O

    MIR022                      R

    MIR026                      O

    MIR023                      O

    MIR024                      R

    MIR088                      R

    MIR025                      O

  • Caption REFC01 – If You Have Any Questions

    REF103                      O

    REF104                      O

    REF106                      O

B. Sequencing for IRMAA predetermination notices for non-T2 beneficiaries

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

  • Introductory (no caption)

    MIR001                      R

    MIR014                      O

    MIR009                      R

    MIR015                     R

  • MIRCO4 – How We Decided Your Income-Related Premium Amount

    MIR080                     O

    MIR081                     O

    MIR084                     O

    MIR030                     O

    MIR019                     R

    MIR020                     R

    MIR097                     O

  • MIRCO3 – If You Have Other Information About Your Income

    MIR021                     O

    MIR027                     O

    MIR022                     R

    MIR026                     O

    MIR023                     O

    MIR024                     R

    MIR088                     R

    MIR025                     O

  • REFC01 – If You Have Any Questions

    REF093                     O

    REF103                     O

    REF104                     O

    REF106                     O


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601190025
HI 01190.025 - Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Predetermination Notices - 08/13/2008
Batch run: 01/27/2009
Rev:08/13/2008