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 can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
|---|
Form and Instruction |
Supporting Statement A |
Supplementary Document |
Form CMS-40B (SP) Application for Enrollment in Medicare Part B (Medical Insurance)
CMS-40B - Supporting Statement.docx
Crosswalk of Changes CMS 40B_508.pdf
Application for Enrollment in Medicare Part B (Medical Insurance) All Historical Document Collections
| Reinstatement with change of a previously approved collection | 2025-03-28 | ||
|
Approved with change |
Revision of a currently approved collection | 2023-11-29 | |
| Extension without change of a currently approved collection | 2020-12-29 | ||
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2018-04-16 | |
|
Approved with change |
Reinstatement without change of a previously approved collection | 2017-07-18 | |
|
Approved without change |
New collection (Request for a new OMB Control Number) | 2014-01-06 |