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WhentoUseSSAFormHowSSAFormWorksLearnhowtofillouttheform,wheretomailit,andwhatisMAGIforMedicareInthisvideo,Iwalkthrough theIRMAAappealform–theformalnameisFormSSAMedicareIncome-RelatedMonthlyAdjustmentAmount–Life-ChangingEvent.Findoutwhenand wheretodownloadtheform,whatitisusedfor,andhowtoaccesstheIRMAAchartsDownloadafillablePDForfillonlineFormSSA,aformtorequesta reductionofMedicarepremiumduetoalife-changingeventProvidetheEINthatwasusedorwillbeusedtoreporttheemployee'swagesontheFormWEnter thedatetheemployeeretiredSeethetableofincome-relatedmonthlyadjustmentamountsbasedonyourtaxfilingstatusandincomeFormSSAisaform providedbytheSSAthatyoucanusetoapplyforareductioninyourIRMAAHowtoFillOutSSAFormYoucancompleteanapplicationforRetirement, Spouse's,MedicareorDisabilityBenefitsonlineSSAanditsaffiliatedStatedisabilitydeterminationserviceshavebeenusingFormSSAsinceTheSSAwas developedinconsultationwiththeDepartmentofHealthandHumanServicesSigntheEnglishSSAintheaddress,city,stateandzipcode.Enter"NotRetired"if theemployeehasnotretired.FormSSAisutilizedtoDownloadyourfillableSSAFormSSAinPDF.TableofContents.Thereisspaceforasecondwitnessif neededOMBPertheMedicareModernizationActof,selectedMedicareinsurancerecipientspayanincome-relatedmonthlyadjustmentamount(IRMAA)You canrequestareductioninyourincome-relatedmonthlyadjustmentamountforMedicarePartBorprescriptiondrugcoveragepremiumsThelinktodownloadthe WhatIsFormSSA?FormSSAcanbeusedtorequestareaseinanindividual'sincome-relatedmonthlyadjustmentamount(IRMAA)Enterthedatethatthe employeelastperformedservices;wasnotexpectedtoFUNCTIONREPORTADULTTHIRDPARTYFormSSABKPurposeofFormSSAThemaingoalof FormSSAistoapplyforareductionintheIncomeRelatedMonthlyAdjustmentAmount(IRMAA)Sucharequestcanbetriggeredwhenanindividual encountersasignificantlifechangethatresultsinareaseinincomeSSAAuthor:SSASubject:MedicareIncome-RelatedMonthlyAdjustmentAmount\rLifeChangingEventKeywords:MedicarePartBIncome-RelatedMonthlyAdjustmentAmountLife-ChangingEvent,MedicarePartB,Income-RelatedMonthly Adjustment,SSA,,life,changing,event,income-related,premiumCreatedDate/7/PMIfyou’vebeennotifiedthatyourpremiumsforeitherMedicarePartBor prescriptiondrugcoverageincludeanIRMAA,thenyoucanfilloutandsubmitthisformifyouexperiencealife-changingeventthatreducesyourincomeLearn howtofilloutandsubmitFormSSAtoreduceyourMedicarePartBorPartDpremiumsifyourincomechangesSSAusesFormSSAtodetermineifarecipient qualifiesforaThisformisforpeoplewhohadamajorlife-changingeventandtheirincomewentdownWITNESS:InthissectionoftheEnglishSSA,onewho knowsthepersonsigningtheformshouldsignasawitnessandprovidehisorherphonenumberoraddressWheretoSendSSAWaystoApplyIfyoucannot submityourapplicationonline:Youcancallusat(TTY);or.TheInternalRevenueService(IRS)transmitsincometaxreturndatatoSSAforSSAtodeterminethe amountofIRMAADuetotheCOVIDpandemic,visitstoourofficesarebyappointmentonlyforcertainservicesEMPLOYERINSTRUCTIONSFOR COMPLETINGSPECIALWAGEPAYMENTFORMspaceprovidediftwosignaturesarerequiredbyStatelawIfyouneedhelpwiththisform,completeas muchofitasyoucanandcallthephonenumberprovidedonthelettersentwiththeform,orcontactthepersonwhoaskedyoutocompletetheformIfyouneed theaddressorphonenumberfortheofficethatprovidedtheform,youcangetitFormSSAisdesignedspecificallyto:maximizetheefficiencyoftheform,as permittedbylaw,tosupportelectroniccommercewithproviders