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.
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•
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