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

ICR 202102-0938-008

OMB: 0938-0251

Federal Form Document

ICR Details
0938-0251 202102-0938-008
Received in OIRA 201804-0938-022
HHS/CMS CM-CPC
Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5)
Revision of a currently approved collection   No
Regular 02/16/2021
  Requested Previously Approved
36 Months From Approved 08/31/2021
1,394,264 51,000
348,566 29,580
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.

US Code: 42 USC 1935i-2 Name of Law: Hospital Insurance Benefits for Uninsured Elderly Individuals not Otherwise Eligible
   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 427 Name of Law: Transitional Insured Status
   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
  
None

Not associated with rulemaking

  85 FR 78333 12/04/2020
86 FR 9349 02/12/2021
No

  Total Request 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 1,394,264 51,000 0 1,393,568 -50,304 0
Annual Time Burden (Hours) 348,566 29,580 0 348,392 -29,406 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This significant increase is a result of improved data provided by SSA, in addition to the transfer of the information technology collection instruments from SSA to CMS. CMS will begin reporting for additional collection instruments, including the Internet Claim System (iClaim) and the Modernized Claims System (MCS) soon to be upgraded to the Consolidated Claims Experience (CCE). The hourly burden from the 2017 approved submission increased from 12,500 hours to 146,673 hours -- a change of 134,173.

$4,285,785
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.
02/10/2021


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