Please rate Form 40B 07-2025
If you don't have Part A, don't complete this application. Contact Social Security to apply for Medicare for the first time.
Enrollment periods: your Initial Enrollment Period, the General Enrollment Period from January 1-March 31 each year, or a Special Enrollment Period if you're eligible.
Where to send: mail or fax your completed, signed form to your local Social Security office.
Premiums: if you sign up for Part B, you must pay premiums for every month you have the coverage.
Employment dates: have your employer fill out the form CMS-L564 (Request for Employment Information) and return it with your application.
Phone: call Social Security at 1-800-772-1213. TTY users call 1-800-325-0778.
| Question | Answer |
|---|---|
| Form Name | Form CMS-40B |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 47 |
| Avg. time to fill out | 8 min |
| Edition | 07/2025 |
| Issuing agency | Centers for Medicare & Medicaid Services |
| Where to send | Your local Social Security office |
| Who signs | The applicant |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | CMS-40B, CMS 40B, CMS40B, 40B, Form CMS-40B, Request for Enrollment in Medicare Part B, Medicare Part B enrollment form |
| Official source | Form CMS-40B (Rev 07/2025), Centers for Medicare & Medicaid Services |
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Please rate Form 40B 07-2025
