01. Edit your application medicare part b form online
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Omb no 0938 1230-2026
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How to use or fill out omb no 0938 1230 with our platform
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- Click ‘Get Form’ to open the OMB No. 0938-1230 application in the editor.
- Enter your Social Security Claim Number and Beneficiary Identification Code (BIC) in the designated fields.
- Indicate whether you wish to sign up for Medicare Part B by marking 'YES' if applicable.
- Fill in your name as it appears on your Social Security records, including last name, first name, and middle name if available.
- Provide your complete mailing address, including street number, P.O. Box, city, state, and ZIP code.
- Input your phone number with area code in the specified field.
- Sign the application in the signature field; do not print your name. If unable to sign, mark an 'X' and ensure a witness completes their information.
- Record the date you signed the application in the appropriate section.
- If applicable, have a witness sign and provide their details as required.
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