OMB control number

Request 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 Request 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.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-18F5 Application for Part A (Hospital Insurance)_Spanish	Form and Instruction
Form CMS-18F5 Request for Enrollment in Medicare Part A (Hospital Insurance)	Form and Instruction
Form CMS-18F5 Interview/SSA Claim System	Form and Instruction
Form CMS-18F5 CAA - SEP UI Mock-ups	Form and Instruction
Form CMS-18F5 iClaim SEP Screens	Form and Instruction
Justification for Collecting Social Security Numbers_.pdf	Supplementary Document
CMS-18F5 - Supporting Statement A (CMS-1848-P version 2).docx	Supporting Statement A
Request for Enrollment in Medicare Part A (Hospital Insurance)	Form and Instruction
Request for Enrollment in Medicare Part A (Hospital Insurance)	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

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202608-0938-005	Revision of a currently approved collection	2026-08-10
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
Form	Name	Electronic access	Type
Form CMS-18F5	Application for Part A (Hospital Insurance)	Fillable Printable	Form and instruction
Form CMS-18F5	Application for Part A (Hospital Insurance)_Spanish	Fillable Printable	Form and instruction

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