A two-part Form CMS-L623 (CMS-L623A) (Notice Regarding Collection of Medical Premiums)
will be generated when medical jurisdiction is transferred from the Social Security
Administration to the Railroad Retirement Board. The Form CMS-L623 is sent to the
beneficiary and Form CMS-L623A (not shown) will be filed on the left side of the folder
for documentation. The form is printed and released from the program service centers.