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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5)

ICR 202506-0938-008 · OMB 0938-0251 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-18F5 Application for Part A (Hospital Insurance)_Spanish Form and Instruction Modified Repair queued
Form CMS-18F5 Application for Part A (Hospital Insurance) Form and Instruction Modified Available
Form CMS-18F5 Application for Part A (Hospital Insurance) Form and Instruction Modified Missing upstream
Form CMS-18F5 Interview/SSA Claim System Form and Instruction Modified Available
Form CMS-18F5 Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) Form and Instruction Modified Repair queued
Form CMS-18F5 CAA - SEP UI Mock-ups Form and Instruction Unchanged Repair queued
Form CMS-18F5 iClaim SEP Screens Form and Instruction Unchanged Available
Form CMS-18F5 Internet Claim (iClaim) Application Form and Instruction Unchanged Available
CMS 18F5 Non-substantive Change Request Memo Final.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-06-18 Repair queued
CMS 18F5 Non-substantive Change Request Memo Final.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-06-18 Repair queued
CMS 18F5 Supporting Statement A_Clean.docx Supporting Statement A Uploaded 2025-06-16 Repair queued
CMS 18F5 Supporting Statement A_Clean.docx Supporting Statement A Uploaded 2025-06-16 Missing upstream
Crosswalk of Changes CMS 18F5 OMB 0938 0251.docx Supplementary Document Uploaded 2025-06-12 Available
Crosswalk of Changes CMS 18F5 OMB 0938 0251.docx Supplementary Document Uploaded 2025-06-12 Missing upstream
Justification for Collecting Social Security Numbers_508.pdf Supplementary Document Uploaded 2024-08-28 Available
Justification for Collecting Social Security Numbers_508.pdf Supplementary Document Uploaded 2024-08-28 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
7908 Application for Part A (Hospital Insurance) Form and Instruction ModifiedApplication for Part A (Hospital Insurance)_Spanish
7908 Application for Part A (Hospital Insurance) Form and Instruction ModifiedApplication for Part A (Hospital Insurance)
7908 Application for Part A (Hospital Insurance) Form and Instruction Modified
245774 Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) Form and Instruction ModifiedInterview/SSA Claim System
245774 Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) Form and Instruction Modified
245773 Internet Claim (iClaim) Application Form and Instruction UnchangedCAA - SEP UI Mock-ups
245773 Internet Claim (iClaim) Application Form and Instruction UnchangediClaim SEP Screens
245773 Internet Claim (iClaim) Application Form and Instruction Unchanged
ICR Details
0938-0251 202506-0938-008
Active 202408-0938-038
HHS/CMS CM-CPC
Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/01/2025
Retrieve Notice of Action (NOA) 06/23/2025
  Inventory as of this Action Requested Previously Approved
11/30/2027 11/30/2027 11/30/2027
1,601,967 0 1,601,967
400,492 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
  
None
Not associated with rulemaking
  89 FR 23598 04/04/2024
89 FR 70191 08/29/2024
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,601,967 1,601,967 0 0 0 0
Annual Time Burden (Hours) 400,492 400,492 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$13,508,629
No
    Yes
    No
No
No
No
No
Stephan McKenzie 410 786-1943 [email protected]
  No
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.
06/23/2025