CMS 40B - Centers for Medicare & Medicaid Services
Jul 1, 2025 · If you don't have Part A, don't complete this application —instead, contact Social Security to apply for Medicare for the first time. Submit your completed and signed form by mail, fax, or by …
Sign up for Part B only | SSA
Fill out the Application for Enrollment in Medicare Part B (CMS-40B) (PDF). If you are applying during the Special Enrollment Period, also fill out the Request for Employment Information (CMS-L564) (PDF).
Enrollment Forms - Medicare
Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.
Application For Enrollment in Medicare Part B
process your SEP enrollment request. Send the application (and the “Request for Employment Information,” if applicable) to your local Social Security Office. Find your local office at www.ssa.gov. …
How to fill out Social Security form CMS-40B and what is it for?
To begin your Medicare Part B enrollment, download the CMS-40B form from the official Social Security website (SSA.gov) or Medicare's site (Medicare.gov). Alternatively, you can request the...
Use this form if you already have Medicare Part A and want to sign up for Part B (Medical Insurance). You can use this form to sign up for Part B during these times: If you don’t have Part A, don’t …
Sign up for Medicare Part B Online, by Fax, or by Mail | SSA
Oct 17, 2024 · If you prefer, you can fax or mail the completed forms – CMS-40B Application for Enrollment in Medicare – Part B (Medical Insurance) and CMS-L564 Request for Employment …