OMB control number
Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event
OMB 0960-0784 · SSA.
OMB 0960-0784
Per the Medicare Modernization Act of 2003, selected Medicare insurance recipients pay an income-related monthly adjustment amount (IRMAA). The Internal Revenue Service (IRS) transmits income tax return data to SSA for SSA to determine the amount of IRMAA. SSA uses Form SSA-44 to determine if a recipient qualifies for a reduction in IRMMA. If affected Medicare recipients believe SSA should use more recent tax data because a life-changing event occurred that significantly reduces their income, they can report these changes to SSA and ask for a new initial determination of their IRMAA.
The latest form for Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event expires 2027-07-31 and is listed under ICR 202010-0960-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-44 Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event | Form and Instruction |
 Supporting Statement - 0784 (Final).docx | Supporting Statement A |
| Supporting Statement - 0784.docx | Supporting Statement A |
| Addendum - 0784.docx | Supplementary Document |
| Addendum - 0784.docx | Supplementary Document |
 Paper Form SSA-44 (mailed or fillable PDF) |
Form and Instruction |
| Paper Form SSA-44 (mailed or fillable PDF) |
Other-0784 Privacy Act Statement (revised) |
| Personal Interview (SSA Field Office) |
Other-Intranet Screens |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202010-0960-002 | Revision of a currently approved collection | 2020-10-02 | ||
| 201811-0960-011 | No material or nonsubstantive change to a currently approved collection | 2018-12-12 | Approved without change | |
| 201703-0960-015 | Revision of a currently approved collection | 2017-06-09 | Approved without change | |
| 201401-0960-001 | Revision of a currently approved collection | 2014-04-23 | Approved without change | |
| 201101-0960-005 | Extension without change of a currently approved collection | 2011-05-26 | Approved without change | |
| 201011-0960-009 | New collection (Request for a new OMB Control Number) | 2010-11-17 | Approved without change | |
| 201011-0960-002 | New collection (Request for a new OMB Control Number) | 2010-11-17 | Withdrawn |
OMB Details
Personal Interview (SSA Field Office)
Federal Enterprise Architecture: Income Security - General Retirement and Disability