The following list contains the sequencing of captions and paragraphs for IRMAA New
Initial Determination Update Notices for Non-T2 beneficiaries. An “R” indicates a
required paragraph, while an “O” indicates an optional paragraph.
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•
Introductory (no caption)
MIR040 R
MIR018 R
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•
COPC01 – Other Information
MIR013 O
-
•
MIRC04 – How We Decided Your Income-Related Premium Amount
MIR041 R
MIR019 R
MIR020 R
MIR114 O
-
•
MIRC05 – If The Information You Gave Us Changes
MIR035 O
-
•
MIRC03 – If You Have Other Information About Your Income
MIR027 O
MIR036 O
MIR024 O
MIR088 O
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•
ALSC19 – If You Disagree With This Decision
ALS162 R
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•
REPC01 – If You Have Any Questions
REP031 R
-
•
REFC01 – If You Have Any Questions
REF093 O
REF103 O
REF104 O
REF106 O