Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE))

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

OMB: 0938-0251

IC ID: 245774

Information Collection (IC) Details

View Information Collection (IC)

Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE))
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-18F5 Interview/SSA Claim System Consolidated Claim Experience (CCE)- Medicare Claim Intake Screen Package_V 3.0.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

515,015 0
   
Individuals or Households
 
   100 %

  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 515,015 0 0 0 0 515,015
Annual IC Time Burden (Hours) 85,853 0 0 0 0 85,853
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy