Your Medicare Forms, Simplified
Medicare Forms (Non-Appeals)
CMS-40B
Application for Enrollment in Medicare Part B
CMS-L564
Request for Employment Information (for Special Enrollment Periods)
CMS-10106
Authorization to Disclose Personal Health Information
CMS-1763
Request to Terminate Premium for Part B/Medigap
CMS-2728-U3
ESRD Medical Evidence Report
SF 5510
Automatic Premium Payment Authorization
Social Security Forms (Non-Appeals)
SSA-1
Application for Retirement Benefits
SSA-44
IRMAA Reduction Request
SSA-89
Authorization for SSN Verification
SSA-3288
Consent to Release SS Information
SSA-7050
Request for Earnings Statement
SSA-1696
Appointment of Representative
SSA-521
Withdrawal of Social Security Application
SSA-632
Waiver of Overpayment Recovery
Medicare Forms:
Appeals Forms:
Follow the specific instructions on the form. You can also contact your Medicare plan or local SSA office for assistance. Always keep a copy for your records.
