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PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. CMS-40B (04/19) 2 Form Approved OMB No. 0938-1230 Expires: 02/20 SPECIAL MESSAGE FOR INDIVIDUAL APPLYING FOR PART B This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you re first eligible for Medicare During the General Enrollment Period (GEP) from January 1 through March 31 of eac.

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