![]() ![]() The Department will use this Generic Application package for discretionary grant programs that: (1) Use the standard ED or Federal-wide grant applications forms that have been cleared separately through OMB under the terms of this generic clearance as approved by OMB and (2) use selection criteria from the Education Department General Administrative Regulations (EDGAR) selection criteria that reflect statutory or regulatory provisions that have been developed under 34 CFR 75.209, or a combination of EDGAR, statutory or regulatory criteria or other provisions, as authorized under 34 CFR 75.200 and 75.209. NOTE: If you don’t already have Part A you can apply online at SSA.gov/benefits/medicare.The Department is requesting an extension of the approval for the Generic Application Package that numerous ED discretionary grant programs use to provide to applicants the forms and information needed to apply for new grants under those grant program competitions. Visit or call Social Security toll-free at 1-80 (TTY 1-80) for more information. ![]() State “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS 40B form or the online application. ![]() ![]() Your employer doesn’t need to sign Section B of the CMS L564 form. You can find your local Social Security office by clicking “SSA Office Locator” under the “Related Links” section below. You can also fax your enrollment forms and evidence of employment and health coverage to your local Social Security office. You’ll also need to send any required proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP) coverage. You can complete the Part B SEP online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) and CMS L564 - Request for Employment Information to your local Social Security office. If you have Medicare Part A (Hospital Insurance) and you’re eligible to enroll in Medicare Part B (Medical Insurance) through a Special Enrollment Period (SEP), you have options for how to apply. ![]()
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