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2. Application for Enrollment in Medicare Part B (Medical Insurance)

   www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf

   This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: • During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare • During the General Enrollment Period (GEP) from January 1 through March 31 of each year

3. CMS40B - Application for Enrollment in Part B | CMS

   www.cms.gov/cms40b-application-enrollment-part-b

   This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

4. Application for Enrollment in Medicare Part B (Medical Insurance)

   www.cms.gov/files/document/cms-40b-application-enrollment-medicare-part-b...

   Application for Enrollment in Medicare Part B (Medical Insurance) DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES. Form Approved. OMB No. 0938-1230 Expires: 04/24.

5. Enrollment Forms - Medicare

   www.medicare.gov/basics/forms-publications-mailings/forms/enrollment

   You lost job-based health coverage within the last 8 months. To sign up for Part B in one of these situations, you’ll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time. Sign up for Part A & Part B using a Special Enrollment Period.

6. Application for Enrollment in Medicare Part B (Medical Insurance)...

   www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/CMS-40B.pdf

   This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

7. Application for Enrollment in Medicare Part B (Medical Insurance)

   omb.report/icr/202012-0938-016/ic/209928

   ⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1230 can be found here: 2023-11-29 - Revision of a currently approved collection

8. APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE)

   www.barnumbenefits.com/wp-content/uploads/2017/02/Medicare-Application.pdf

   Form Approved. OMB No. 0938-1230. APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE) 1. Your Social Security Claim Number – –

9. Application for Enrollment in Medicare Part B (Medical Insurance)

   omb.report/icr/202311-0938-011/ic/209928

   OMB 0938-1230. ICR 202311-0938-011. IC 209928 ( ) Documents and Forms. Document Name. Document Type. Form CMS-40B (SP) ... Fillable Printable: Form and Instruction: CMS-40B: Application for Enrollment in Medicare Part B (Medical Insurance) CMS-40B_508_01.09.24.pdf Yes: No: Fillable Printable:

10. CMS 40B | CMS - Centers for Medicare & Medicaid Services

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339

    You can apply online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) to your local Social Security office.

11. Application for Enrollment in Medicare Part B (Medical Insurance)

    www.healthcarenavigation.com/wp-content/uploads/2024/05/CMS-40B-Form-Only.pdf

    Application for Enrollment in Medicare Part B (Medical Insurance) DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES. Form Approved. OMB No. 0938-1230 Expires: 01/25.