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 can be found here.

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OMB Details

Application for Part A (Hospital Insurance)

Federal Enterprise Architecture: Health - Health Care Services

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.