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

• •

  Introductory (no caption)

  MIR001                      R

  MIR014                      O

  MIR009                      R

  MIR002                      R

  MIR065                      R

  MIR006                      O

  MIR007                      R

  MIR017                      O

  MIR008                      R

• •

  Caption MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR080                      O

  MIR081                      O

  MIR084                      O

  MIR030                      O

  MIR019                      R

  MIR020                      R

  MIR097                      O

• •

  Caption MIRC03 – If You Have Other Information About Your Income

  MIR021                      O

  MIR027                      O

  MIR022                      R

  MIR026                      O

  MIR023                      O

  MIR024                      R

  MIR088                      R

  MIR025                      O

• •

  Caption REFC01 – If You Have Any Questions

  REF103                      O

  REF104                      O

  REF106                      O

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

• •

  Introductory (no caption)

  MIR001                      R

  MIR014                      O

  MIR009                      R

  MIR015                     R

• •

  MIRCO4 – How We Decided Your Income-Related Premium Amount

  MIR080                     O

  MIR081                     O

  MIR084                     O

  MIR030                     O

  MIR019                     R

  MIR020                     R

  MIR097                     O

• •

  MIRCO3 – If You Have Other Information About Your Income

  MIR021                     O

  MIR027                     O

  MIR022                     R

  MIR026                     O

  MIR023                     O

  MIR024                     R

  MIR088                     R

  MIR025                     O

• •

  REFC01 – If You Have Any Questions

  REF093                     O

  REF103                     O

  REF104                     O

  REF106                     O