CMS-18F5 CAA - SEP UI Mock-ups

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

Proposed CAA - SEP UI Mock-ups -

Internet Claim (iClaim) Application

OMB: 0938-0251

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SEP UI Mockups

Landing Page with no prior SEP occurrences



Add SEP Page prior to SEP selection

Add SEP with International Volunteer Selected



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTodd Owens
File Modified0000-00-00
File Created2023-08-30

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