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Federal forms, ICRs, and supporting documents

Information Collection

Application for Enrollment in Medicare Part B (Medical Insurance)

IC 209928 under ICR 201804-0938-005 · OMB 0938-1230.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Application for Enrollment in Medicare Part B (Medical Insurance)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-40B (SP) Solicitud De Inscripci?n Para Medicare Parte B (Seguro M?dico) CMS-40B_SP_508 2017.pdf https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-S.pdf Yes No Fillable Printable
Form and Instruction CMS-40B Application for Enrollment in Medicare Part B (Medical Insurance) CMS 40-B 508.pdf Yes No Fillable Printable

Health Health Care Services

 

400,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400,000 0 0 0 0 400,000
Annual IC Time Burden (Hours) 100,000 0 0 0 0 100,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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