Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount, 20 CFR 418.1350

OMB 0960-0762

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-54 Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount Form and Instruction
SSA-54 (0960-NEW) supporting statement.doc Supporting Statement A
Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount Form and Instruction