TN 1 (10-07)

HI 01190.095 Sequencing for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Reconsideration – Reversal Notices

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

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

  • Introductory (no caption)

    MIR099 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 R

    MIR117 R

    MIR019 R

    MIR020 R

    MIR114 O

  • MIRC03 – If You Have Other Information About Your Income

    MIR021 R

    MIR024 R

    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

B. Sequencing for IRMAA Annual Verification Reconsideration – Reversal Notices for Non-T2 Beneficiaries

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

  • Introductory (no caption)

    MIR099 R

    MIR060 R

    MIR018 R

  • COPC01 – Other Information

    MIR013 O

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

    MIR080 R

    MIR117 R

    MIR019 R

    MIR020 R

    MIR114 O

  • MIRC03 – If You Have Other Information About Your Income

    MIR021 R

    MIR024 R

    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 (RRB) O

    REF103 O

    REF104 O

    REF106 O


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601190095
HI 01190.095 - Sequencing for Income-Related Monthly Adjustment Amount (IRMAA)