HI 01001.384 Memorandum for Premium Arrearages Based on Equitable Relief
TO: |
Railroad Retirement Board |
|
Health Insurance Operations |
|
844 Rush Street |
|
Chicago, Illinois 60611 |
FROM: |
SSA PSC NE MAT AW FL MM QN ODO DIO |
SUBJECT: |
SMI Premium Arrearages Based on Equitable Relief |
Take the following actions on this case:
RRB claim number
SSA claim number
Name
Check the appropriate box:
□ 1. Waiver request - Development made by district office
□ 2. Beneficiary in: □ current pay □ suspense □ uninsured status
Comments: