IRS Form 8821, "Tax Information Authorization," authorizes the disclosure of your tax information.

If you disagree with the decision Social Security made on your request for reconsideration about your Medicare Part B income-related premium, you can ask for a hearing before an Administrative Law Judge (ALJ) of the Department of Health and Human Services (HHS). Social Security needs to redisclose your tax information to the ALJ for your hearing. In order for Social Security to do so, you need to complete and sign IRS Form 8821, "Tax Information Authorization," granting Social Security authority to disclose this information to the ALJ. You can find the form and guidance on how to complete it at www.socialsecurity.gov/online/irs-8821.pdf. 

IRS Form 8821, "Tax Information Authorization," is not a request for a hearing. You also need to request a hearing in writing by completing a "Request for Hearing by Administrative Law Judge" (HA-501-U5). You can find the request for a hearing online at www.socialsecurity.gov/online/ha-501.pdf or request a copy through the Social Security Administration’s toll-free number 1-800-772-1213 (TTY 1-800-325-0778), or you can contact your local Social Security office to file your hearing.

To file a hearing you will need to complete both forms, "Tax Information Authorization" (IRS Form 8821) and "Request for Hearing by Administrative Law Judge " (HA-501-U5).

For more information, visit the Social Security Administration’s website at www.socialsecurity.gov/mediinfo.htm, call toll-free at 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office.

To learn more about Medicare Part B coverage, visit www.medicare.gov.