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

• •

  Introductory (no caption)

  MIR087                    R

  MIR060                    R

  MIR004                    R

  MIR065                    R

  MIR016                    O

  MIR006                    O

  MIR007                    R

  MIR017                    O

  MIR008                    R

• •

  MIRC02 – Another Letter

  MIR010                    R

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR080                    O

  MIR081                    O

  MIR084                    O

  MIR030                    O

  MIR019                    R

  MIR020                    R

  MIR114                    O

• •

  MIRC03 – If You Have Other Information About Your Income

  MIR021                    R

  MIR024                    O

  MIR022                    R

  MIR088                    R

  MIR025                    R

• •

  ALSC19 – If You Disagree With This Decision

  ALS163                    R

• •

  ALSC25 – If You Want Help With Your Hearing

  REP032                    R

• •

  REFC01 – If You Have Any Questions

  REF103                    O

  REF104                  O

  REF106                  O

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

• •

  Introductory (no caption)

  MIR087                   R

  MIR060                   R

  MIR018                   R

• •

  COPC01 – Other Information

  MIR013                  O

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR080                  O

  MIR081                  O

  MIR084                  O

  MIR030                  O

  MIR019                  R

  MIR020                  R

  MIR114                  O

• •

  MIRC03 – If You Have Other Information About Your Income

  MIR021                  R

  MIR024                  O

  MIR022                  R

  MIR088                  R

  MIR025                  R

• •

  ALSC19 – If You Disagree With This Decision

  ALS163                  R

• •

  ALSC25 – If You Want Help With Your Hearing

  REP032                  R

• •

  REFCO1 – If You Have Any Questions

  REF093                 O

  REF103                 O

  REF104                 O

  REF106                 O