Information Collection Request
Application for Enrollment in Medicare Part A, Internet Claim (iClaim) Application Screen, Modernized Claims System and Consolidated Claim (CMS-18F5)
ICR 202304-0938-004 · OMB 0938-0251 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0251 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
Modified |
Form |
Modified |
Form and Instruction |
Unchanged |
Form and Instruction |
Unchanged |
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Justification for No Material/Nonsubstantive Change | 2023-04-10 |
Justification for No Material/Nonsubstantive Change | 2023-04-10 |
Supplementary Document | 2023-04-10 |
Supplementary Document | 2023-04-10 |
Supporting Statement A | 2021-05-25 |
Supporting Statement A | 2021-05-25 |
Supplementary Document | 2021-02-12 |
Supplementary Document | 2021-02-12 |
Form CMS-18F5 Application for Part A (Hospital Insurance)
Non-sub Change Request Memo CMS 18F5.docx
Justification for Collecting Social Security Numbers.pdfIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 7908 | Modified | ||
| 7908 | Modified | ||
| 245774 | Unchanged | ||
| 245774 | Unchanged | ||
| 245773 | Modified | ||
| 245773 | Modified |
Application for Part A (Hospital Insurance)ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0251 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202102-0938-008 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-04-11 |
| Requested Expiration Date | 1969-12-31 |