TN 1 (10-07)

HI 01190.070 Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Overage Notices

A. Sequencing for Income-Related Monthly Adjustment (IRMAA) Annual Verification Overage Notices for T2 Beneficiaries

The following list contains the sequencing of captions and paragraphs for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Overage notices for T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

  • Introductory (no caption)

    MIR093 R

    MIR094 R

  • Caption MIRC02 – Another Letter

    MIR012 O

  • Caption INFC01 – The Information We Have

    MIR107 R

    MIR002 R

    MIR065 R

    MIR016 O

    MIR006 O

    MIR007 R

    MIR017 o

    MIR008 R

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

    MIR102 O

    Or MIR103 O

    MIR106 O

    MIR105 O

    MIR108 O

    Or MIR109 O

    MIR019 O

    MIR020 O

    MIR114 O

  • Caption ALSC19 – If You Disagree With This Decision

    ALS162 R

  • Caption REPC01 – If You Want Help With Your Appeal

    REP031 R

  • Caption REFC01 – If You Have Any Questions

    REF103 O

    REF104 O

    REF106 O

B. Sequencing for IRMAA Annual Verification Overage Notices for Non-T2 Beneficiaries

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

  • Introductory (no caption)

    MIR093 R

    MIR094 R

  • COPC01 – Other Information

    MIR122 (OPM) O

    MIR124 (RRB) O

  • INFC01 – The Information We Have

    MIR107 R

    MIR018 R

  • MIRC04 – How We Decided Your Income-Related Premium Amount

    MIR102 O

    Or MIR103 O

    MIR106 O

    MIR105 O

    MIR108 O

    Or MIR109 O

    MIR019 O

    MIR020 O

    MIR114 O

  • ALSC19 – If You Disagree With This Decision

    ALS162 R

  • REPC01 – If You Want Help With Your Appeal

    REP031 R

  • REFC01 – If You Have Any Questions

    REF093 (RRB) O

    REF103 O

    REF104 O

    REF106 O


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601190070
HI 01190.070 - Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Overage Notices - 08/14/2008
Batch run: 01/27/2009
Rev:08/14/2008