OMB control number
Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount, 20 CFR 418.1350
OMB 0960-0762 · SSA.
OMB 0960-0762
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-54 Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount | Form and Instruction |
 SSA-54 (0960-NEW) supporting statement.doc | Supporting Statement A |
 Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 200710-0960-003 | New collection (Request for a new OMB Control Number) | 2007-10-23 | Approved with change |