Application for Enrollment in Medicare - The Medical Insurance Program (CMS-40B)

OMB 0938-1230

The Form CMS-40B is used to establish enrollment in Supplementary Medical Insurance (Part B). The information collected on the form is needed to determine an individual's eligibility for Medicare Part B.

The latest form for Application for Enrollment in Medicare - The Medical Insurance Program (CMS-40B) expires 2021-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-40B (SP) Application for Enrollment in Medicare Part B (Medical Insurance) Form and Instruction
40-B Response to Comment.docx Supplementary Document
Crosswalk of Changes CMS 40B.pdf Supplementary Document
CMS-40B - Supporting Statement A clean.docx Supporting Statement A
Application for Enrollment in Medicare Part B (Medical Insurance) Form and Instruction

All Historical Document Collections

202311-0938-011 Approved with change	Revision of a currently approved collection	2023-11-29
202012-0938-016	Extension without change of a currently approved collection	2020-12-29
201804-0938-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-04-16
201707-0938-007 Approved with change	Reinstatement without change of a previously approved collection	2017-07-18
201401-0938-003 Approved without change	New collection (Request for a new OMB Control Number)	2014-01-06