The following list contains the sequencing of captions and paragraphs for IRMAA New Initial Determination Dismissal Notices for T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR070                  R

• •

  MIRC10 – About Your Request For A New Decision

  MIR071                  O

  MIR073                  O

  MIR072                  O

  MIR086                  O

• •

  MIRC03 – If You Have Other Information About Your Income

  MIR074                  O

  MIR052                  R

  MIR082                  R

• •

  · REFC01 – If You Have Any Questions

  REF103                  O

  REF104                  O

  REF106                 O

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

• •

  Introductory (no caption)

  MIR070                     R

• •

  MIRC10 – About Your Request For A New Decision

  MIR071                     O

  MIR073                     O

  MIR072                     O

  MIR086                     O

• •

  MIRC03 – If You Have Other Information About Your Income

  MIR074                     O

  MIR052                     R

  MIR082                     R

• •

  REFC01 – If You Have Any Questions

  REF093                     O

  REF103                     O

  REF104                     O

  REF106                     O