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Federal forms, ICRs, and supporting documents

Information Collection

Application for Part A (Hospital Insurance)

IC 7908 under ICR 202408-0938-038 · OMB 0938-0251.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Application for Part A (Hospital Insurance)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 406.7 42 CFR 406.10 42 CFR 406.20 42 CFR 406.6 42 CFR 406.11

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-18F5 Application for Part A (Hospital Insurance) CMS-18-F-5-508C.docx Yes No Fillable Printable
Form and Instruction CMS-18F5 Application for Part A (Hospital Insurance)_Spanish CMS-18-F-5 (508)enabled Spanish.docx Yes No Fillable Printable

Health Health Care Services

 

7,499 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,499 0 0 6,803 696 0
Annual IC Time Burden (Hours) 1,875 0 0 1,701 174 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.