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The valid OMB control number for this information collection is 0938-1230. The time required to complete this information is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources,
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1230.
Contact Social Security if you want to apply for Medicare for the first time. WHEN DO YOU USE THIS APPLICATION? If you’re in your Initial Enrollment Period (IEP) and live in Puerto Rico. You must sign up for Part B using this form. If you want to sign up for Part B during the General Enrollment Period (GEP) from January 1 – March 31 each year.
Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.
The valid OMB control number for this information collection is 0938-1230. The time required to complete this information is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources,
OMB No. 0938-1230 Expires: 01/25 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE) CMS-40B (01/24) 2 10. Written Signature (DO NOT PRINT) SIGN HERE 11. Date Signed / / 12. Signature of Witness 13. Date Signed / / – – 1. Your Medicare Number 2.
Remarks According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1230.
The valid OMB control number for this information collection is 0938-1230. The time required to complete this information is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources,
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.
⚠️ Notice: This information collection may be referencing outdated material.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