Get Irmaa Information Instruction Form - Nyc.gov

Filling out the Irmaa Information Instruction Form is essential to claim additional reimbursements for Medicare Part B premiums that exceed the standard amount. This guide provides clear, step-by-step instructions to help users easily navigate the form and submit their claims online.

Follow the steps to successfully complete the form.

1. Press the 'Get Form' button to obtain the form and open it in the designated editor.
2. Begin filling out Section 1 for retiree information by entering your last name, first name, middle initial, address, and Social Security number. Ensure all details are accurate and complete.
3. Proceed to Section 2 for dependent information. Provide the last name, first name, middle initial, and Social Security number of your eligible dependent. Verify that all information is correct.
4. In Section 3, carefully check the boxes to indicate that you have included the required documents for both the retiree and the eligible dependent. Ensure you have a copy of the Social Security Administration letter and Form SSA-1099 or proof of payment.
5. Review the completed form for any errors or omissions. Make necessary corrections to avoid delays in processing.
6. Once all information is confirmed, save your changes. You may then download, print, or share the completed form as necessary.

Start filling out your Irmaa Information Instruction Form online today to ensure you receive the reimbursements you may be entitled to.