Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Part A (Hospital Insurance) Modified 696 174 0 Form CMS-18F5
Internet Claim (iClaim) Application New 878553 219638 0
Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) New 515015 85853 0 Form and Instruction CMS-18F5
Total burden requested under this ICR: 1394264 305665 0  
To view an IC, click on IC Title