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Printable Form 8633 Louisville Kentucky: What You Should Know

Note: If you can't download or print the form, you must print the form out. You must return to IRS.gov/Fulfillment within 30 days to: NOTICE OF DENIAL OF MEDICARE PART D PRESCRIPTION DRUG COVERAGE (Form 1099-MISC) by Kentucky Taxpayer Services, Inc. NOTICE OF MEDICARE PART D QUALIFIED ADJUSTMENT FOR A QUALIFIED HEALTH PLAN by Kentucky Taxpayer Services, Inc. Notice of Denial of Medicare Part D Prescription Drug Coverage If you qualify for Medicare Part D prescription drug coverage and are denied one of these drugs in part or full, you must fill out and return the following form (the FORM 8633) (or you can print the form below) to the following address: Louisville KY. Taxpayer Services, Inc (the tax preparer), 10300 Madison Ave., Suite 200, Louisville, KY 40217, U.S.A. Telephone/Mail:, Fax:. Fax (No Reply):. NOTE: The Kentucky Taxpayer Services, Inc. will mail the form to you. There are no fees for filing this form. Your Kentucky Taxpayer Services, Inc. is authorized to accept the following forms: Medicare Part B, Medicare Part D, Medicare supplement, and private health. You may also send this form to the office where you received your initial physician determination letter or the physician whose letter you received and to the office of the physician or entity that provided the form, so you can have the notice sent to them. The Kentucky Taxpayer Services, Inc. is NOT authorized to accept the following Forms 1099, 5498, W-2, 829, 1099, 809, and T4EZ. NOTE: The Kentucky Taxpayer Services, Inc. will not charge a fee to the taxpayer under this tax. You must return to IRS.gov/Fulfillment within 30 days to: Medicare Prescription Drug Plan Form 8633, Lexington KY. Taxpayer Services, Inc, 10300 Madison Ave., Suite 200, Louisville, KY 40217, U.S.A. Telephone/Mail:, Fax: (502 was the number on the letter on the return). Payment is a non-refundable fee.

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