Get Omb No 0938 1230 2020-2026

This guide provides clear and step-by-step instructions on how to fill out the Omb No 0938 1230 online. Designed for users at all levels of experience, this resource aims to simplify the process of enrolling in Medicare Part B.

Follow the steps to complete your application for Medicare Part B.

1. Click ‘Get Form’ button to obtain the document and open it in the online editor.
2. Provide your Social Security Claim Number, including any letters that form your Beneficiary Identification Code (BIC).
3. Indicate whether you wish to sign up for Medicare Part B by marking 'YES' or 'NO'. Note that this form is only for those who already have Medicare Part A.
4. Enter your full name. Write your last name first, followed by your first name and middle name, if applicable.
5. Fill in your mailing address, ensuring to include your street number and name, P.O. Box, or route.
6. Input the city, state, and ZIP code corresponding to your mailing address.
7. Provide your 10-digit phone number, including the area code.
8. Sign your name in the designated area. If you are unable to sign, you may mark an 'X' and will need a witness.
9. Write the date you signed the application.
10. If applicable, have a witness sign the application if your signature is marked as 'X'.
11. Have the witness provide the date of their signature.
12. Include the witness's address for further verification, if necessary.
13. Add any remarks or comments that clarify information about your enrollment application.
14. If you are applying through a Special Enrollment Period (SEP) due to group health plan coverage, ensure to include Form CMS-L564 completed by your employer.

Complete your application online to ensure timely enrollment in Medicare Part B.