- Form #
- CMS 40B
- Form Title
- APPLICATION FOR ENROLLMENT IN MEDICARE
- Revision Date
- 01/01/1990
- O.M.B. #
- EXEMPT
- O.M.B. Expiration Date
- N/A
- CMS Manual
- N/A
- Special Instructions
- You must either visit or contact the Social Security Administration office to obtain this form. 1-800-772-1213; TTY 1-800-325-0778
