Get Form Approved Omb No. 0938-1230

This guide provides clear and supportive instructions for filling out the Form Approved OMB No. 0938-1230, which is used for applying for enrollment in Medicare Part B (Medical Insurance). By following these steps, users can efficiently complete the form online and ensure their application is submitted correctly.

Follow the steps to successfully complete the enrollment application

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Your Medicare number: Enter your Medicare number in the designated field.
3. Do you wish to sign up for Medicare Part B (Medical Insurance)? Mark 'YES' if you want to enroll in Medicare Part B, indicating you already have Medicare Part A.
4. Your name: Write your last name, first name, and middle name as per your Social Security or Medicare application.
5. Mailing address: Fill in your complete mailing address including the number, street name, P.O. Box, or route.
6. City, state, and ZIP code: Provide your city name, state, and ZIP code corresponding to your mailing address.
7. Phone number: Input your 10-digit phone number, including the area code.
8. Written signature: Sign your name as you would on any official document. Avoid printing.
9. Date signed: Enter the date you are signing the application.
10. If applicable, provide witness details: If you marked 'X' instead of signing, a witness must sign and complete their details.
11. Add remarks: Provide any additional comments or clarifications necessary for your application.
12. Final steps: Review your application for accuracy, then save changes, download, print, or share the completed form as required.

Complete your enrollment application for Medicare Part B online now.