Information Collection

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

IC 245774 under ICR 202304-0938-004 · OMB 0938-0251.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0251 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-18F5 Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE))	Form and Instruction
Form CMS-18F5 Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE))	Form and Instruction
CMS-18F5 Interview/SSA Claim System Consolidated Claim Experience (CCE)- Medicare Claim Intake Screen Package_V 3.0.pdf	Form and Instruction
CMS-18F5 Interview/SSA Claim System Consolidated Claim Experience (CCE)- Medicare Claim Intake Screen Package_V 3.0.pdf	Form and Instruction

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 515,015

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	515,015	515,015
Annual IC Time Burden (Hours)	85,853	85,853
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.