Application for Enrollment in Medicare Part B (Medical Insurance) (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 Part B (Medical Insurance) (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
CMS-40B - Supporting Statement.docx Supporting Statement A
Crosswalk of Changes CMS 40B_508.pdf Supplementary Document
Application for Enrollment in Medicare Part B (Medical Insurance) Form and Instruction

All Historical Document Collections

202501-0938-012	Reinstatement with change of a previously approved collection	2025-03-28
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