TN 1 (10-07)

HI 01190.080 Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Correction Notices

A. Sequencing for IRMAA Annual Verification Correction Notices for T2 Beneficiaries

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

  • Introductory (no caption)

    MIR050 O

    Or MIR101 O

    Or MIR118 & MIR119 O

    NOTE: If MIR118 generates, MIR119 is required.

  • MIRC02 – Another Letter

    MIR011 R

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

    MIR108 R

    MIR019 R

    MIR020 R

  • 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

    REF103 O

    REF104 O

    REF106 O

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

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

  • Introductory (no caption)

    MIR050 O

    Or MIR101 O

    Or MIR118 OR MIR119 O

  • COPC01 – Other Information

    MIR013 (OPM) O

    MIR123 (RRB) O

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

    MIR108 R

    MIR019 R

    MIR020 R

  • 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/0601190080
HI 01190.080 - Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Correction Notices - 08/14/2008
Batch run: 01/27/2009
Rev:08/14/2008