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

• •

  Introductory (no caption)

  MIR069                   R

• •

  MIRC10 – About Your Request For A New Decision

  MIR071                   O

  MIR073                   O

  MIR072                   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 Update Dismissal Notices for Non-T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR069                   R

• •

  MIRC10 – About Your Request For A New Decision

  MIR071                   O

  MIR073                   O

  MIR072                   O

• •

  MIRC03 – If You Have Other Information About Your Income

  MIR074                   O

  MIR052                   R

  MIR082                   R

• •

  REFCO1 – If You Have Any Questions

  REF093                   O

  REF103                   O

  REF104                   O

  REF106                   O