OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0938-0251 · HHS/CMS.

OMB 0938-0251

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.

The latest form for Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5) expires 2027-11-30 and is listed under ICR 202506-0938-008.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-18F5 Application for Part A (Hospital Insurance)_SpanishForm and Instruction
Form CMS-18F5 Application for Part A (Hospital Insurance)Form and Instruction
Form CMS-18F5 Application for Part A (Hospital Insurance)Form and Instruction
Form CMS-18F5 Interview/SSA Claim SystemForm and Instruction
Form CMS-18F5 Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE))Form and Instruction
Form CMS-18F5 CAA - SEP UI Mock-upsForm and Instruction
Form CMS-18F5 iClaim SEP ScreensForm and Instruction
Form CMS-18F5 Internet Claim (iClaim) ApplicationForm and Instruction
CMS 18F5 Non-substantive Change Request Memo Final.docxJustification for No Material/Nonsubstantive Change
CMS 18F5 Non-substantive Change Request Memo Final.docx Justification for No Material/Nonsubstantive Change
CMS 18F5 Supporting Statement A_Clean.docxSupporting Statement A
Crosswalk of Changes CMS 18F5 OMB 0938 0251.docxSupplementary Document
Crosswalk of Changes CMS 18F5 OMB 0938 0251.docx Supplementary Document
Justification for Collecting Social Security Numbers_508.pdfSupplementary Document
Justification for Collecting Social Security Numbers_508.pdf Supplementary Document
Application for Part A (Hospital Insurance) Form and Instruction
Application for Part A (Hospital Insurance) Form and Instruction
Application for Part A (Hospital Insurance) Form and Instruction
Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) Form and Instruction
Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) Form and Instruction
Internet Claim (iClaim) Application Form and Instruction
Internet Claim (iClaim) Application Form and Instruction
Internet Claim (iClaim) Application Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202506-0938-008 No material or nonsubstantive change to a currently approved collection 2025-06-23
202408-0938-038 Reinstatement with change of a previously approved collection 2024-08-29
202304-0938-004 No material or nonsubstantive change to a currently approved collection 2023-04-11 Approved with change
202102-0938-008 Revision of a currently approved collection 2021-02-16 Approved without change
201804-0938-022 Reinstatement without change of a previously approved collection 2018-04-25 Approved with change
201402-0938-013 Extension without change of a currently approved collection 2014-02-26 Approved without change
201012-0938-021 Extension without change of a currently approved collection 2010-12-30 Approved without change
200708-0938-006 Extension without change of a currently approved collection 2007-08-15 Approved without change
200408-0938-003 Extension without change of a currently approved collection 2004-08-20 Approved with change
200107-0938-014 Extension without change of a currently approved collection 2001-07-26 Approved without change
199807-0938-015 Reinstatement without change of a previously approved collection 1998-07-24 Approved without change
199503-0938-003 Reinstatement without change of a previously approved collection 1995-03-09 Approved without change
199103-0938-006 Extension without change of a currently approved collection 1991-03-18 Approved without change
198908-0938-007 Extension without change of a currently approved collection 1989-08-31 Approved without change
198607-0938-003 Revision of a currently approved collection 1986-07-29 Approved without change
198408-0938-021 No material or nonsubstantive change to a currently approved collection 1984-08-13 Approved with change
198310-0938-027 Reinstatement with change of a previously approved collection 1983-10-19 Approved without change
198201-0938-006 Revision of a currently approved collection 1982-01-22 Approved without change

OMB Details

Application for Part A (Hospital Insurance)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form CMS-18F5Application for Part A (Hospital Insurance)Fillable PrintableForm and instruction
Form CMS-18F5Application for Part A (Hospital Insurance)_SpanishFillable PrintableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.