Non-Substantive Justification

To: Jamie Wilson

Office of Information and Regulatory Affairs (OIRA)

Office of Management and Budget (OMB)

From: XXX

Centers for Medicare Services (CMS)

Medicare Enrollment and Appeals Group (MEAG/Division of Eligibility and Enrollment (DEEP)

Date: March XX, 2023

Subject: Non-substantive Change Request – Application for Part A (Hospital Insurance) (OMB #0938-0251)

This memo requests approval of non-substantive changes to the approved information collection, Application for Part A (Hospital Insurance) (OMB #0938-0251).

Background

Medicare is a federal program to provide health insurance for people age 65 and older, and those under 65 with certain disabilities or end-stage renal disease (ESRD). Individuals who are entitled to retirement or disability benefits under Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits are automatically entitled to Medicare Hospital Insurance (Part A) when they attain age 65 or reach the 25^th month of disability benefit entitlement. These individuals do not file a separate application for Part A because their application for Social Security or RRB benefits is also an application for Part A. Individuals who are not entitled to or eligible for RRB or SSA benefits must apply for Part A. SSA process applications on behalf of CMS.

Individuals that must apply for Medicare can enroll during their initial enrollment period (IEP), the general enrollment period (GEP), or, if they qualify, a special enrollment period (SEP). One of the conditions in which an individual can enroll during an SEP is if they were an international volunteer.

The CMS-18-F-5 (Application for Enrollment in Part A (Hospital Insurance)) was designed to capture all the information needed to make a determination of an individual’s entitlement to Part A. Individuals complete the form and submit it to SSA to complete the enrollment. As an alternative, individuals can apply using the following electronic mechanisms:

• Online at ssa.gov via SSA’s internet Claim System (iClaim)

• Phone or in-office interview where responses are stored in the Modernized Claims System (MCS) and the Consolidated Claim Experience (CCE)

The electronic collection instruments are currently OMB approved under this package and also under SSA package 0960-0618. CMS has ownership of this collection only as it relates to Medicare, for the purposes of ICR review, PRA-compliance responsibilities, and ownership of the burden associated with the information collection. The operation of the information collection, including both electronic submission via iClaim as well as interview-based submission at field offices (which are ultimately recorded in MCS or the CCE), continues to be controlled by SSA. The changes described in this memo are related to Medicare only, and therefore, no changes will be submitted under SSA package 0960-0618.

The form CMS-10797 (OMB # 0938-1426) is used by individuals who seek to enroll using an SEP. The electronic mechanisms iClaim and UI SEP are approved under this package.

Overview of Requested Changes

There is a question pertaining to an individual’s SEP for international volunteer work and subsequent health coverage. This data element is captured on the paper form, as well as, the electronic mechanism, CCE and is currently approved under this package. SSA has been continuously improving their electronic mechanisms, seeking to improve the beneficiary’s enrollment experience. In the latest update, SSA has developed online screens to allow individuals to apply for an SEP for international volunteers using the iClaim electronic mechanism. The screens that CMS seeks to add to this package are currently approved under OMB 0938-1426.

CMS seeks this change request to include the international volunteer data element under SSA’s iClaim. This change does not add any new questions or requests for information. It only adds the ability to use an electronic mechanism to enroll in Part A for individuals who were international volunteers. We don’t expect a change in burden, but will monitor enrollments and make adjustments during the next renewal process.

Time Sensitivities

Individuals seeking to enroll in Medicare likely have an urgent need to obtain health insurance. This change will allow individuals who were international volunteers an opportunity to self-complete their application online, rather than waiting for an appointment with SSA. This could, in turn, allow individuals sooner access to Medicare benefits. If the package is not cleared, this puts the agency at risk of delaying respondent enrollment.