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Federal forms, ICRs, and supporting documents

Information Collection

Application for Enrollment in Medicare Part B (Medical Insurance)

IC 209928 under ICR 202501-0938-012 · OMB 0938-1230.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Enrollment in Medicare Part B (Medical Insurance)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-40B (SP) Solicitud De Inscripcion En La Parte De Medicare (Seguro Medico) Spanish_CMS-40B_508_Enabled revised.pdf https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-S.pdf Yes No Fillable Printable
Form and Instruction CMS-40B Application for Enrollment in Medicare Part B (Medical Insurance) CMS-40B-051525.docx Yes No Fillable Printable
Instruction CMS-40B Telephonic Attestation.docx Yes Yes Printable Only
Form and Instruction CMS-40B Enrollment Screenshots Enrollment Screenshots for CMS-40B.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,184,546 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,184,546 0 0 115,831 1,068,715 0
Annual IC Time Burden (Hours) 292,820 0 0 27,532 265,288 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - CMS-40B CMS-40B Current form redlined (1).pdf 03/21/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.