OMB control number
Application for Enrollment in Medicare Part B (Medical Insurance) (CMS-40B)
OMB 0938-1230 · HHS/CMS.
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 Part B (Medical Insurance) (CMS-40B) expires 2028-07-31 and is listed under ICR 202501-0938-012.
Latest Forms, Documents, and Supporting Material
Form CMS-40B Enrollment Screenshots
Form CMS-40B (SP) Solicitud De Inscripcion En La Parte De Medicare (Seguro Medico)
Application for Enrollment in Medicare Part B (Medical Insurance)All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202501-0938-012 | Reinstatement with change of a previously approved collection | 2025-03-28 | ||
| 202311-0938-011 | Revision of a currently approved collection | 2023-11-29 | Approved with change | |
| 202012-0938-016 | Extension without change of a currently approved collection | 2020-12-29 | ||
| 201804-0938-005 | No material or nonsubstantive change to a currently approved collection | 2018-04-16 | Approved without change | |
| 201707-0938-007 | Reinstatement without change of a previously approved collection | 2017-07-18 | Approved with change | |
| 201401-0938-003 | New collection (Request for a new OMB Control Number) | 2014-01-06 | Approved without change |