Social Security Part B Enrollment Form

Many forms must be completed only by a social security representative.

Social security part b enrollment form.

Your employer doesn t need to sign section b of the cms l564 form. You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage. The form you are looking for is not available online. 1395o 1395s and 1395ii for your enrollment in medicare part b.

Or contact your local social security office. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. You can also fax the cms 40b and cms l564 to 1 833 914 2016. State i want part b coverage to begin mm yy in the remarks section of the cms 40b form or the online application.

Get this form and instructions in spanish. 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. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m. Call social security at 1 800 772 1213 tty.

1395o 1395s and 1395ii for your enrollment in medicare part b. You will need to sign up for it during your initial enrollment period or you will pay a penalty. 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. Or return forms by mail to 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 to free at 1 800 772 1213 tty 1 800 325 0778 for more information. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. If you don t already have part a you can apply online at ssa gov benefits medicare.

There s 3 ways you can sign up. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. Fax them to 1 833 914 2016. Call social security at 1 800 772 1213.

Fill out a short form and send it to your local social security office. Please contact social security at 1 800 772 1213 tty 1 800 325. If you live in puerto rico you will not receive medicare part b medical insurance automatically. Or return the forms by mail to your local social security office.

If you get benefits from the railroad retirement board contact your local. If you worked for a railroad call the rrb at 1 877 772 5772. Tty users can call 1 800 325 0778. When do i sign up.

You can complete form cms 40b application for enrollment in medicare part b medical insurance and cms l564 request for employment information online. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016.