View Information Collection (IC)
View Information Collection (IC)

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) https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-S.pdf Yes No Fillable Printable
Form and Instruction CMS-40B Yes No Fillable Printable
Instruction Yes Yes Printable Only
Form and Instruction CMS-40B 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 03/21/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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