E-changing event and your income has gone down, you may use this form to request a reduction in your income-related monthly adjustment amount. See page 5 for detailed information and line-by-line instructions. If you prefer to schedule an interview with your local Social Security office, call 1-800-772-1213 (TTY 1-800-325-0778). Name Social Security Number You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums.
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How to fill out the SSA-44 online
The SSA-44 form is designed for requesting a reduction in your income-related monthly adjustment amount due to a life-changing event. This guide provides clear, step-by-step instructions on how to complete the SSA-44 online, ensuring you have the necessary information and support.
Follow the steps to successfully fill out the SSA-44 online.
- Press the ‘Get Form’ button to access the SSA-44 and open it in a digital format.
- Identify the type of life-changing event you experienced. Check the appropriate box and fill in the date the event occurred (mm/dd/yyyy). Options include marriage, work reduction, divorce/annulment, loss of income-producing property, death of your partner, loss of pension income, work stoppage, or employer settlement payment.
- Enter the tax year in which your income was impacted by the life-changing event, along with your adjusted gross income (AGI) and tax-exempt interest for that specific tax year. Also, select your tax filing status from the provided options.
- If applicable, indicate whether your modified adjusted gross income will be lower next year and provide the estimated adjusted gross income, estimated tax-exempt interest, and expected tax filing status for that year.
- Compile documentation to support your application. You can either attach the necessary documents for mailing or show original copies to a Social Security employee during an interview.
- Review the information carefully, then sign the form, including your phone number, mailing address, and any other required details.
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