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  • Ssa-44 2013

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D gross income (AGI, as used on line 37 of IRS form 1040) and tax-exempt interest income (as used on line 8b of IRS form 1040), and your tax filing status. Tax Year Adjusted Gross Income Tax-Exempt Interest 2 0 __ __ $ __ __ __ __ __ __ . __ __ $ __ __ __ __ __ __ . __ __ Tax Filing Status for this Tax Year (choose ONE ): Single Head of Household Married, Filing Jointly Married, Filing Separately Qualifying Widow(er) with Dependent Child STEP 3: Modified Adjusted Gross Income Will your .

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How to fill out the SSA-44 online

The SSA-44 form is designed for individuals experiencing a life-changing event that may affect their Medicare Income-Related Monthly Adjustment Amount (IRMAA). This guide will provide step-by-step instructions to help you fill out the form correctly and efficiently online.

Follow the steps to complete your SSA-44 form online

  1. Click ‘Get Form’ button to obtain the SSA-44 and open it in your online editor.
  2. Select one life-changing event that accurately describes your situation and enter the date it occurred in the mm/dd/yyyy format.
  3. Indicate the tax year during which your income was affected by the life-changing event. Provide your adjusted gross income and tax-exempt interest income for that year, along with your tax filing status.
  4. If applicable, check 'Yes' to indicate whether your modified adjusted gross income will be lower next year. If so, fill in the anticipated income and tax filing status for that year.
  5. Provide documentation to substantiate your modified adjusted gross income and life-changing event. You can attach original documents or provide certified copies as required.
  6. Read the information carefully before signing the form. Provide your signature, phone number, and current mailing address to ensure that the Social Security Administration can contact you if necessary.

Start filling out your SSA-44 online today to request a reduction in your income-related monthly adjustment amount.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
SSA-44
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