Information Collection Request
Application for Enrollment in Medicare Part B (Medical Insurance) (CMS-40B)
ICR 202501-0938-012 · OMB 0938-1230 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-40B (SP) Application for Enrollment in Medicare Part B (Medical Insurance) |
Form and Instruction | Modified | Missing upstream |
 CMS-40B - Supporting Statement.docx |
Supporting Statement A | Uploaded 2025-03-21 | Repair queued |
 Crosswalk of Changes CMS 40B_508.pdf |
Supplementary Document | Uploaded 2025-01-23 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 209928 |  Application for Enrollment in Medicare Part B (Medical Insurance) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1230 |
| Type of Information Collection | Reinstatement with change of a previously approved collection |
| Previous ICR Reference No | 202311-0938-011 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |