The SSA SSA-44 form is a document used by individuals to request a reduction in their monthly Social Security benefits due to a change in income. This form allows beneficiaries to report significant life changes that may affect their financial situation. To take action, fill out the form by clicking the button below.
The SSA SSA-44 form is an important document for individuals seeking to adjust their Social Security benefits due to changes in income. This form specifically allows beneficiaries to request a reduction in their income-related monthly adjustment amount (IRMAA), which can significantly impact their overall financial situation. By filling out the SSA-44, individuals can provide the Social Security Administration with updated information about their current income, including any significant decreases that may have occurred since their last assessment. This process is essential for ensuring that beneficiaries receive the correct amount of benefits, especially in light of changing life circumstances such as retirement, job loss, or other financial hardships. Understanding how to properly complete and submit the SSA-44 can help individuals navigate the complexities of the Social Security system and secure the benefits they rightfully deserve.
Form SSA-44 (12-2024)
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Discontinue Prior Editions
Social Security Administration
OMB No. 0960-0784
Medicare Income-Related Monthly Adjustment Amount -
Life-Changing Event
If you had a major life-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 include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event that may reduce your IRMAA. To decide your IRMAA, we asked the Internal Revenue Service (IRS) about your adjusted gross income plus certain tax-exempt income which we call "modified adjusted gross income" or MAGI from the Federal income tax return you filed for tax year 2023. If that was not available, we asked for your tax return information for 2022. We took this information and used the table below to decide your income-related monthly adjustment amount.
The table below shows the income-related monthly adjustment amounts for Medicare premiums based on your tax filing status and income. If your MAGI was lower than $106,000.01 (or lower than $212,000.01 if you filed your taxes with the filing status of married, filing jointly) in your most recent filed tax return, you do not have to pay any income-related monthly adjustment amount. If you do not have to pay an income-related monthly adjustment amount, you should not fill out this form even if you experienced a life-changing event.
Your Part B
Your prescription
drug coverage
If you filed your taxes as:
And your MAGI was:
monthly
adjustment is:
-Single,
$106,000.01 - $133,000.00
$ 74.00
$ 13.70
-Head of household,
-Qualifying widow(er) with dependent
$133,000.01 - $167,000.00
$185.00
$ 35.30
child, or
$167,000.01 - $200,000.00
$295.90
$ 57.00
$200,000.01 - $499,999.99
$406.90
$ 78.60
-Married filing separately (and you did
More than $499,999.99
$443.90
$ 85.80
not live with your spouse in tax year)*
$212,000.01 - $266,000.00
$266,000.01 - $334,000.00
-Married, filing jointly
$334,000.01 - $400,000.00
$400,000.01 - $749,999.99
More than $750,000.00
-Married, filing separately (and you
$106,000.01 - $393,999.99
lived with your spouse during part of
More than $393,999.99
that tax year)*
*Let us know if your tax filing status for the tax year was Married, filing separately, but you lived apart from your spouse at all times during that tax year.
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STEP 1: Type of Life-Changing Event
Check any life-changing event and fill in the date(s) that the events occurred (mm/yyyy).
Marriage
Work Reduction
Divorce/Annulment
Loss of Income-Producing Property
Death of Your Spouse
Loss of Pension Income
Work Stoppage
Employer Settlement Payment
Date(s) of life-changing event:
(mm/yyyy)
If you have had or anticipate having a life-changing event, you can report to us an income reduction that has already occurred or an income reduction that you anticipate occurring this or next year. Use Step 2 to report reductions that have already occurred, and Step 3 to report reductions you are anticipating occurring. Additional instructions available on page 6).
STEP 2: Reductions in Income that have Already Occurred
If your income has already been reduced by the life-changing event (see instructions on page 6), the amount of your adjusted gross income (AGI, as used on line 11 of IRS form 1040) and tax-exempt interest income (as used on line 2a of IRS form 1040), and your tax filing status.
Tax Year
Adjusted Gross Income
Tax-Exempt Interest
2 0 __ __
$ __ __ __ __ __ __ . __ __
Tax Filing Status for this Tax Year (choose ONE ):
Single
Head of Household
Qualifying Widow(er)
with Dependent Child
Married, Filing Jointly
Married, Filing Separately
STEP 3: Anticipated Reductions in Modified Adjusted Gross Income Next Year
Will your modified adjusted gross income be lower next year than the year in Step 2?
No - Skip to STEP 4
Yes - Complete the blocks below for next year
Estimated Adjusted Gross Income
Estimated Tax-Exempt Interest
$ __ __ __ __ __ __. __ __
Expected Tax Filing Status for this Tax Year (choose
ONE ):
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STEP 4: Documentation
Provide evidence of your modified adjusted gross income (MAGI) and your life-changing event. You can either:
1.Attach the required evidence and we will mail your original documents or certified copies back to you;
OR
2.Show your original documents or certified copies of evidence of your life-changing event and modified adjusted gross income to an SSA employee.
Note: You must sign in Step 5 and attach all required evidence. Make sure that you provide your current address and a phone number so that we can contact you if we have any questions about your request.
STEP 5: Signature
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE SIGNING THIS FORM.
I understand that the Social Security Administration (SSA) will check my statements with records from the Internal Revenue Service to make sure the determination is correct.
I declare under penalty of perjury that I have examined the information on this form and it is true and correct to the best of my knowledge.
I understand that signing this form does not constitute a request for SSA to use more recent tax year information unless it is accompanied by:
•Evidence that I have had the life-changing event indicated on this form;
•A copy of my Federal tax return; or
•Other evidence of the more recent tax year's modified adjusted gross income
Signature
Phone Number
Mailing Address
Apartment Number
City
State
ZIP Code
Page 4 of 8
Privacy Act Statement
Collection and Use of Personal Information
Sections 1839(i) and 1860D-13(a) of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent an accurate and timely decision on your income-related monthly adjustment amount (IRMAA).
We will use the information you provide to determine if you qualify for a reduction in or elimination of IRMAA. We may also share the information for the following purposes, called routine uses:
•To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA in the efficient administration of its programs. We contemplate disclosing information under this routine use only in situations in which SSA may enter into a contractual or similar agreement with a third party to assist in accomplishing an agency function relating to this system of records; and
•To applicants, claimants, prospective applicants or claimants (other than the data subjects and their authorized representatives) to the extent necessary for the purpose of administering Medicare Part A, Part B, Medicare Advantage Part C, and Medicare Part D, including but not limited to pursuing Medicare Part B, Part C and Part D premium collection.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0321, Medicare Database File, as published in the Federal Register (FR) on July 25, 2006, at 71 FR 42159. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.
Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. We estimate that it will take about 45 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
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INSTRUCTIONS FOR COMPLETING FORM SSA-44
Medicare Income-Related Monthly Adjustment Amount
Life-Changing Event--Request for Use of More Recent Tax Year Information
You do not have to complete this form in order to ask that we use your information about your modified adjusted gross income for a more recent tax year. If you prefer, you may call
1-800-772-1213 and speak to a representative from 7 a.m. until 7 p.m. on business days to request an appointment at one of our field offices. If you are hearing-impaired, you may call our TTY number, 1-800-325-0778.
Identifying Information
Print your full name and your own Social Security Number as they appear on your Social Security card. Your Social Security Number may be different from the number on your Medicare card.
STEP 1
You should choose any life-changing event on the list. Fill in the date that the life-changing event occurred. The life-changing event date must be in the same year or an earlier year than the tax year you ask us to use to decide your income-related premium adjustment. For example, if we used your 2023 tax information to determine your income-related monthly adjustment amount for 2025, you can request that we use your 2024 tax information instead if you experienced a reduction in your income in 2024 due to a life-changing event that occurred in 2024 or an earlier year.
Use this category if...
You entered into a legal marriage.
Your legal marriage ended, and you will not file a joint return
with your spouse for the year.
Your spouse died.
Work Stoppage or Reduction
You or your spouse stopped working or reduced the hours
that you work.
You or your spouse experienced a loss of income-producing
property that was not at your direction (e.g., not due to the
Loss of Income-Producing
sale or transfer of the property). This includes loss of real
property in a Presidentially or Gubernatorially-declared
Property
disaster area, destruction of livestock or crops due to natural
disaster or disease, or loss of property due to arson, or loss
of investment property due to fraud or theft.
You or your spouse experienced a scheduled cessation,
termination, or reorganization of an employer's pension plan.
You or your spouse receive a settlement from an employer
or former employer because of the employer's bankruptcy or
reorganization.
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STEP 2
Supply information about the more recent year's modified adjusted gross income (MAGI). Note that this year must reflect a reduction in your income due to the life-changing event(s) you listed in Step 1. A change in your tax filing status due to the life-changing event might also reduce your income-related monthly adjustment amount. Your MAGI is your adjusted gross income as used on line 11 of IRS form 1040 plus your tax-exempt interest income as used on line 2a of IRS form 1040. We used your MAGI and your tax filing status to determine your income-related monthly adjustment amount.
•Fill in both empty spaces in the box that says “20_ _". The year you choose must be more recent than the year of the tax return information we used. The letter that we sent you tells you what tax year we used.
•Choose this year (the "premium year") - if your modified adjusted gross income is lower this year than last year. For example, if you request that we adjust your income-related premium for 2025, use your estimate of your 2025 MAGI if:
1.Your income was not reduced until 2025; or
2.Your income was reduced in 2024, but will be lower in 2025.
•Choose last year (the year before the "premium year," which is the year for which you want us to adjust your IRMAA) - if your MAGI is not lower this year than last year. For example, if you request that we adjust your 2025 income-related monthly adjustment amounts and your income was reduced in 2024 by a life-changing event AND will be no lower in 2025, use your tax information for 2024.
•Exception: If we used IRS information about your MAGI 3 years before the premium year, you may ask us to use information from 2 years before the premium year. For example, if we used your income tax return for 2022 to decide your 2025 IRMAA, you can ask us to use your 2023 information.
•If you have any questions about what year you should use, you should call SSA.
•Fill in your actual or estimated adjusted gross income for the year you wrote in the “tax year” box. Adjusted gross income is the amount on line 11 of IRS form 1040. If you are providing an estimate, your estimate should be what you expect to enter on your tax return for that year.
Tax-exempt Interest Income
•Fill in your actual or estimated tax-exempt interest income for the tax year you wrote in the “tax year” box. Tax-exempt interest income is the amount reported on line 2a of IRS form 1040. If you are providing an estimate, your estimate should be what you expect to enter on your tax return for that year.
Filing Status
•Check the box in front of your actual or expected tax filing status for the year you wrote in the “tax year” box.
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STEP 3
Complete this step only if you expect that your MAGI for next year will be even lower. We will record this information and use it next year to determine your Medicare income-related monthly adjustment amounts. If you do not complete Step 3, we will use the information from Step 2 next year to determine your income-related monthly adjustment amounts, unless one of the conditions described in “Important Facts” on page 8 occurs.
•Fill in both empty spaces in the box that says “20 _ _ ” with the year following the year you wrote in Step 2. For example, if you wrote "2025" in Step 2, then write "2026" in Step 3.
•Fill in your estimated adjusted gross income for the year you wrote in the “tax year” box. Adjusted gross income is the amount you expect to enter on line 11 of IRS form 1040 when you file your tax return for that year.
•Fill in your estimated tax-exempt interest income for the tax year you wrote in the “tax year” box. Tax-exempt interest income is the amount you expect to report on line 2a of IRS form 1040.
•Check the box in front of your expected tax filing status for the year you wrote in the “tax year” box.
STEP 4
Provide your required evidence of your MAGI and your life-changing event.
Modified Adjusted Gross Income Evidence
If you have filed your Federal Income tax return for the year you wrote in Step 2, then you must provide us with your signed copy of your tax return or a transcript from IRS. If you provided an estimate in Step 2, you must show us a signed copy of your tax return when you file your Federal income tax return for that year.
Life-Changing Event Evidence
We must see original documents or certified copies of evidence that the life-changing event occurred. Required evidence is described on the next page. In some cases, we may be able to accept another type of evidence. If you do not have a preferred document listed on the next page. Ask a Social Security representative to explain what documents can be accepted.
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Life Changing Event
Evidence
An original marriage certificate: or a certified copy of a public record of marriage.
A certified copy of the decree of divorce or annulment.
A certified copy of a death certificate, certified copy of the public record of death, or
a certified copy of a coroner's certificate.
An original signed statement from your employer; copies of pay stubs; original or
Work Stoppage or
certified documents that show a transfer of your business.
Reduction
Note: In the absence of such proof, we will accept your signed statement, under
penalty of perjury, on this form, that you parially or dully stopped working or
accepted a job with reduced compensation.
Loss of Income
An original copy of an insurance company adjuster's statement of loss or a letter
from a State or Federal government about the uncompensated loss. If the loss was
Producing Property
due to investment fraud (theft), we also require proof of conviction for the theft,
such as a court document citing theft or fraud relating to your or your spouse's loss.
A letter or statement from your pension fund administrator that explains the
reduction or termination of your benefits.
Employer Settlement
A letter from the employer stating the settlement terms of the bankruptcy court and
Payment
how it affects you or your spouse.
STEP 5
Read the information above the signature line, and sign the form. Fill in your phone number and current mailing address. It is very important that we have this information so that we can contact you if we have any questions about your request.
Important Facts
•When we use your estimated MAGI information to make a decision about your income- related monthly adjustment amount, we will later check with the IRS to verify your report.
•If you provide an estimate of your MAGI rather than a copy of your Federal tax return, we will ask you to provide a copy of your tax return when you file your taxes.
•If your estimate of your MAGI changes, or you amend your tax return for that reason, you will need to contact us to update our records. If you do not contact us, we may have to make corrections later including retroactive assessments or refunds.
•We will use your estimate provided in Step 2 to make a decision about the amount of your income-related monthly adjustment amounts the following year until:
•IRS sends us your tax return information for the year used in Step 2; or
•You provide a signed copy of your filed Federal Income tax return or amended Federal Income tax return with a different amount; or
•You provide an updated estimate.
•If we used information from IRS about a tax year when your filing status was Married filing separately, but you lived apart from your spouse at all times during that year, you should contact us at 1-800-772-1213 (TTY 1-800-325-0778) to explain that you lived apart from your spouse. Do not use this form to report this change.
After obtaining the SSA SSA-44 form, individuals will need to carefully complete it to ensure accurate processing. Following the instructions below will facilitate the filling out of the form.
What is the SSA SSA-44 form?
The SSA SSA-44 form, also known as the "Request for Reconsideration of a Determination of Disability," is a document used by individuals who are seeking to appeal a decision made by the Social Security Administration (SSA) regarding their disability benefits. This form allows applicants to request a review of the SSA's previous decision, whether it was a denial of benefits or a reduction in benefits. Completing this form is an important step for those who believe they qualify for disability but have not received the appropriate support from the SSA.
Who should fill out the SSA SSA-44 form?
Individuals who have received a notice from the SSA indicating that their claim for disability benefits has been denied or that their current benefits have been reduced should consider filling out the SSA SSA-44 form. It is specifically designed for those who wish to contest the SSA's decision and provide additional information or evidence that may support their case. If you believe your condition meets the criteria for disability benefits, this form is an essential tool in your appeal process.
How do I obtain the SSA SSA-44 form?
You can obtain the SSA SSA-44 form from the official Social Security Administration website. The form is available for download in PDF format, making it easy to print and fill out. Alternatively, you can visit your local SSA office to request a physical copy of the form. If you prefer, you can also call the SSA's toll-free number to ask for the form to be mailed to you.
What information do I need to provide on the SSA SSA-44 form?
When filling out the SSA SSA-44 form, you will need to provide personal information such as your name, Social Security number, and contact details. Additionally, you should include details about your medical condition, any treatments you have received, and how your condition affects your ability to work. It is important to be thorough and accurate, as this information will help the SSA in their review of your case.
How long does it take to process the SSA SSA-44 form?
The processing time for the SSA SSA-44 form can vary based on several factors, including the complexity of your case and the current workload of the SSA. Generally, it may take several weeks to a few months for the SSA to review your request and issue a decision. It is advisable to keep track of your submission and follow up with the SSA if you have not received a response within a reasonable timeframe.
What should I do if my appeal is denied again?
If your appeal is denied after submitting the SSA SSA-44 form, you still have options. You can request a hearing before an administrative law judge, which is the next step in the appeals process. It is crucial to gather any additional evidence that may support your case and consider seeking assistance from a disability attorney or advocate. They can help you navigate the appeals process and improve your chances of a favorable outcome.
Filling out the SSA SSA-44 form can be a straightforward process, but many individuals encounter common pitfalls that can delay their application or even lead to denial. One frequent mistake is providing incomplete information. Each section of the form requires specific details, and leaving any part blank can raise questions or cause the Social Security Administration (SSA) to return the form for additional information.
Another common error involves miscalculating income. The SSA-44 form is designed to assess changes in income, and inaccuracies can lead to significant problems. Applicants must ensure that they report their income accurately, including wages, pensions, and any other sources. Failing to include all sources or misreporting amounts can result in incorrect benefit calculations.
Additionally, many individuals overlook the importance of providing supporting documentation. The SSA often requires evidence to substantiate claims made on the form. Neglecting to include necessary documents can lead to delays in processing. It is advisable to gather all relevant paperwork before submitting the form to ensure a smooth review process.
Another mistake is not signing the form. While it may seem trivial, an unsigned SSA-44 form is considered invalid. It is essential to review the form thoroughly before submission to confirm that all required signatures are present. This small step can save time and prevent unnecessary complications.
Lastly, some applicants fail to keep copies of their submitted forms. Retaining a copy is crucial for future reference, especially if any issues arise during the review process. Having a record of what was submitted can help clarify any misunderstandings and facilitate communication with the SSA.
The SSA SSA-44 form, also known as the "Request for Reconsideration of the Reduction of Your Social Security Benefits," is an important document for individuals seeking to appeal a reduction in their Social Security benefits. When navigating the complexities of Social Security, it’s helpful to be aware of other forms and documents that may accompany the SSA-44. Here’s a brief overview of some commonly used forms that can aid in the process.
Understanding these forms and how they relate to the SSA SSA-44 can significantly enhance your ability to navigate the Social Security system. Each document plays a vital role in ensuring that your case is thoroughly reviewed and that you receive the benefits you deserve.
The SSA SSA-44 form, used to request a reconsideration of a previous decision regarding Social Security benefits, shares similarities with several other documents in the realm of Social Security Administration processes. Here are five documents that are comparable to the SSA-44 form:
When filling out the SSA SSA-44 form, it's important to ensure accuracy and completeness. Here are ten essential tips to help you navigate the process effectively.
By following these guidelines, you can help ensure a smoother experience when submitting your SSA SSA-44 form.
The SSA-44 form, also known as the "Request for Reconsideration of a Disability Cessation," is often misunderstood. Below are four common misconceptions regarding this form, along with clarifications to provide accurate information.
This is incorrect. The SSA-44 form is used by individuals whose disability benefits have been terminated or ceased. It allows them to request a reconsideration of that decision.
This is not true. While submitting the form allows for a reconsideration, it does not guarantee a favorable outcome. The Social Security Administration will review the case and make a decision based on the evidence provided.
This is misleading. There are strict deadlines for submitting the SSA-44 form. Individuals must submit the form within a specific timeframe following the cessation of benefits to ensure their request is considered.
This is an oversimplification. While the SSA-44 form is a crucial step, individuals may also need to provide additional documentation or evidence to support their case during the appeal process.
The SSA SSA-44 form is used to request a reduction in the amount of Social Security benefits due to changes in income. Here are some key takeaways to consider when filling out and using this form: