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 Name |
|---|
Form and Instruction |
Supporting Statement A |
Form SSA-54 Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount
SSA-54 (0960-NEW) supporting statement.doc
Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount All Historical Document Collections
|
Approved with change |
New collection (Request for a new OMB Control Number) | 2007-10-23 |