Social Security Part B Enrollment Form

You can also fax your enrollment forms and evidence of employment to 1 833 914 2016.

Social security part b enrollment form.

You can complete form cms 40b application for enrollment in medicare part b medical insurance and cms l564 request for employment information online. 1395o 1395s and 1395ii for your enrollment in medicare part b. Fill out a short form and send it to your local social security office. Get this form and instructions in spanish.

Tty users can call 1 800 325 0778. Your employer doesn t need to sign section b of the cms l564 form. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. You will need to sign up for it during your initial enrollment period or you will pay a penalty.

There s 3 ways you can sign up. Social security and the centers for medicare medicaid services cms need your information to determine if you. To sign up please call our toll free number at 1 800 772 1213 tty 1 800 325 0778 you also may contact your local social security office. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c.

Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. If you live in puerto rico you will not receive medicare part b medical insurance automatically. Please contact social security at 1 800 772 1213 tty 1 800 325. If you don t already have part a you can apply online at ssa gov benefits medicare.

Visit faq ssa gov or call social security to free at 1 800 772 1213 tty 1 800 325 0778 for more information. 1395o 1395s and 1395ii for your enrollment in medicare part b. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m. Or return the forms by mail to your local social security office.

When do i sign up. If you get benefits from the railroad retirement board contact your local. You can also fax the cms 40b and cms l564 to 1 833 914 2016. Call social security at 1 800 772 1213 tty.

Fax them to 1 833 914 2016. The form you are looking for is not available online. Call social security at 1 800 772 1213. Visit your local social security office.

State i want part b coverage to begin mm yy in the remarks section of the cms 40b form or the online application. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c. Or contact your local social security office.

If you worked for a railroad call the rrb at 1 877 772 5772. Or return forms by mail to your local social security office.