Form SSA-1021 Appeal of Determination for Extra Help With Medicare Prescription Drug Plan Costs

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Instructions for Form SSA-1021 Appeal of Determination for Extra Help With Medicare Prescription Drug Plan Costs

What Is Form SSA-1021?

This is a legal form that was released by the U.S. Social Security Administration on April 1, 2021 and used country-wide. Check the official instructions before completing and submitting the form.

Form Details:

• Released on April 1, 2021;
• The latest available edition released by the U.S. Social Security Administration;
• Easy to use and ready to print;
• Yours to fill out and keep for your records;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a fillable version of Form SSA-1021 by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.