Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

OMB 0960-0784

OMB 0960-0784

Per the Medicare Modernization Act of 2003, selected Medicare insurance recipients pay an income-related monthly adjustment amount (IRMAA). The Internal Revenue Service (IRS) transmits income tax return data to SSA for SSA to determine the amount of IRMAA. SSA uses Form SSA-44 to determine if a recipient qualifies for a reduction in IRMMA. If affected Medicare recipients believe SSA should use more recent tax data because a life-changing event occurred that significantly reduces their income, they can report these changes to SSA and ask for a new initial determination of their IRMAA. This is a non-substantive Change Request to update the adjusted income amounts based on the new CY 2019 figures.

The latest form for Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event expires 2021-01-31 and can be found here.

OMB Details

Personal Interview (SSA Field Office)

Federal Enterprise Architecture: Income Security - General Retirement and Disability


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