TN 1 (10-07)

HI 01190.075 Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Predetermination Notices

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

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

  • Introductory (no caption)

    MIR092 R

    MIR094 R

    MIR095 R

  • INFC01 – The Information We Have

    MIR107 R

    MIR002 R

    MIR065 R

    MIR006 O

    MIR007 R

    MIR017 O

    MIR120 R

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

    MIR102 O

    Or MIR103 O

    Or MIR115 & MIR116 O

    MIR108 O

    Or MIR109 O

    MIR019 R

    MIR020 R

    NOTE: If MIR115 generates, MIR116 is required.

  • MESC01 – What You Can Do

    MIR110 R

  • REFC01 – If You Have Any Questions

    REF103 O

    REF104 O

    REF106 O

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

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

  • Introductory (no caption)

    MIR092 R

    MIR094 R

    MIR095 R

  • INFC01 – The Information We Have

    MIR107 R

    MIR121 R

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

    MIR102 O

    Or MIR103 O

    Or MIR115 & MIR116 O

    MIR108 O

    Or MIR109 O

    MIR019 R

    MIR020 R

    NOTE: If MIR115 generates, MIR116 is required.

  • MESC01 – What You Can Do

    MIR110 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/0601190075
HI 01190.075 - Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Predetermination Notices - 08/14/2008
Batch run: 01/27/2009
Rev:08/14/2008