Emergency Clearance Letter

June 29, 2010

Office of Information and Regulatory Affairs, OMB

Room 10235, New Executive Office Bldg.

725 17^th St. NW

Washington, D.C. 20503

Attn: Kevin W. Herms

Dear Mr. Herms,

The Social Security Administration (SSA) needs to revise an existing OMB-approved form, the SSA-44 (OMB No. 0960-0735, Medicare Part B Income-Related Premium - Life-Changing Event). Because we are making these changes to conform to soon-to-be-published regulations whose provisions will be effective on publication, we are requesting emergency OMB approval. Below we provide background information on the proposed changes and the rules dictating these modifications.

Background

Medicare Part B, Supplementary Medical Insurance helps pay for doctors’ services and outpatient care. It also covers other medical services, such as physical and occupational therapy and some home health care. Beneficiaries who elect coverage under Part B pay monthly premiums. The Social Security Act (“the Act”) requires deduction of Medicare Part B premiums from monthly Social Security payments.

In most cases, the government pays about 75 percent of the Part B premium, while the beneficiary pays the remaining 25 percent. Since 2007, higher income beneficiaries pay a larger percentage of the total cost of Medicare Part B premiums (as per section 1839 of the Act, amended by section 811 of Public Law 108-173, the Medicare Modernization Act of 2003 (MMA)). There are four levels of adjustment, based on the beneficiary’s most recent income data, as provided by the Internal Revenue Service. The amount by which SSA reduces the federal Medicare Part B subsidy is called the income-related monthly adjustment amount, or IRMAA.

If Medicare Part B enrollees subject to IRMAA experience one of multiple life-changing events, (LCE) they can ask SSA to use a more recent taxable year on which to base its adjustments. As defined by the MMA, these LCEs currently include: 1) marriage, 2) divorce/annulment,

3) spousal death, 4) work stoppage, 5) work reduction, 6) loss of income due to property loss, and 7) loss of pension income.

Form SSA-44

If Medicare Part B enrollees experience one of the LCEs, they use form SSA-44 to document this LCE and ask SSA to use more updated taxable data on which to base the adjustments. Based on the information provided by the form, SSA determines if the LCE meets the established criteria and if we will honor the request to use different tax data.

In several weeks, SSA plans to publish regulations at RIN 0960-AH06 (docket no. SSA-2009-0078). These rules will expand the definition of property loss and will add a new life-changing event: receipt of a one-time employer’s settlement payment. We will revise form SSA-44 to include the expanded and new LCEs. The attached Supporting Statement and Addendum to the Supporting Statement outline the specific changes we are making.

Because these new rules will be effective on publication, we must have the revised form in place by the time they publish. We are therefore requesting emergency clearance one week from today, Tuesday, July 6, 2010. Please contact SSA’s Reports Clearance Officer, Faye I. Lipsky, at 410-965-8783 or [email protected] with any questions about this collection.

Sincerely,

Faye I. Lipsky

Reports Clearance Officer

Social Security Administration