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

OMB 0938-0251

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 2021-08-31 and can be found here.

All Historical Document Collections
Revision of a currently approved collection 2021-02-16
Approved with change
Reinstatement without change of a previously approved collection 2018-04-25
Approved without change
Extension without change of a currently approved collection 2014-02-26
Approved without change
Extension without change of a currently approved collection 2010-12-30
Approved without change
Extension without change of a currently approved collection 2007-08-15
Approved with change
Extension without change of a currently approved collection 2004-08-20
Approved without change
Extension without change of a currently approved collection 2001-07-26
Approved without change
Reinstatement without change of a previously approved collection 1998-07-24
Approved without change
Reinstatement without change of a previously approved collection 1995-03-09
Approved without change
Extension without change of a currently approved collection 1991-03-18
Approved without change
Extension without change of a currently approved collection 1989-08-31
Approved without change
Revision of a currently approved collection 1986-07-29
Approved with change
No material or nonsubstantive change to a currently approved collection 1984-08-13
Approved without change
Reinstatement with change of a previously approved collection 1983-10-19
Approved without change
Revision of a currently approved collection 1982-01-22

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