The following list contains the sequencing of captions and paragraphs for IRMAA New
Initial Determination Update Dismissal Notices for Non-T2 beneficiaries. An “R” indicates
a required paragraph, while an “O” indicates an optional paragraph.
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•
Introductory (no caption)
MIR069 R
-
•
MIRC10 – About Your Request For A New Decision
MIR071 O
MIR073 O
MIR072 O
-
•
MIRC03 – If You Have Other Information About Your Income
MIR074 O
MIR052 R
MIR082 R
-
•
REFCO1 – If You Have Any Questions
REF093 O
REF103 O
REF104 O
REF106 O