Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5)
Reinstatement with change of a previously approved collection
No
Regular
08/29/2024
Requested
Previously Approved
36 Months From Approved
1,601,967
0
400,492
0
0
0
The form CMS 18 (and 18SP) is used to establish entitlement to Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) by individuals who do not qualify for entitlement based upon entitlement to a Social Security or Railroad Retirement benefits.
PL:
Pub.L. 42 - 406 11
Name of Law: Individual age 65 or over who is not eligible as a social security or railroad retirement benefits
US Code:
42 USC 1395i-2a
Name of Law: Hospital Insurance Benefits for Disabled Individuals Who Have Exhausted Other Entitilements
PL:
Pub.L. 42 - 406 20
Name of Law: Premium Hospital Insurance - Basic Requirements
PL:
Pub.L. 42 - 406 6
Name of Law: Application or enrollment for hospital insurance
PL:
Pub.L. 42 - 406 7
Name of Law: Forms to apply for entitlement under Medicare Part A
US Code:
42 USC 426
Name of Law: Entitlement to Hospital Insurance Benefits
PL:
Pub.L. 42 - 406 10
Name of Law: Hospital Insurance Eligibility and Entitlement
US Code:
42 USC 1935i-2
Name of Law: Hospital Insurance Benefits for Uninsured Elderly Individuals not Otherwise Eligible
US Code:
42 USC 427
Name of Law: Transitional Insured Status
The hourly burden from the 2021 approved submission increased from 146,673 hours to 400,493 hours -- a change of 253,820. This change in burden is due to the increase in respondents. The number of respondents newly enrolling in Medicare can vary due to the number of individuals that become eligible yearly.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-18F5 Application for Part A (Hospital Insurance)
CMS-18F5 - Supporting Statement A.docx
Crosswalk of Changes CMS 18F5 OMB 0938 0251.pdf
Application for Part A (Hospital Insurance)