TAILIEUCHUNG - Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

Mover’s Distance (EMD) to explicitly align the volumes. In contrast to the fixed volume-to-volume matching used in [25], the space-time volumes of two videos across different space-time locations can be matched using our ASTPM method, making it better at coping with the large intraclass variations within the same type of events (., moving objects in consumer videos can appear at different space- time locations, and the background within two different videos, even captured from the same scene, may be shifted due to considerable camera motion). The second is ourmain contribution. In order to copewith the considerable variation between feature distributions of videos from the web video domain and consumer video domain, we propose. | _ . _ Form Approved 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 2011. If that was not available we asked for your tax return information for 2010. 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 85 or lower than 170 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. If you filed your taxes as And your MAGI was Your Part B monthly adjustment is Your prescription drug coverage monthly adjustment is -Single -Head of household -Qualifying widow er with dependent child or -Married filing separately and you did not live with .

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