Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Part A (Hospital Insurance) Modified 7499 1875 0 Form and Instruction CMS-18F5
Form and Instruction CMS-18F5
Internet Claim (iClaim) Application Unchanged 1134262 283565 0 Form and Instruction CMS-18F5
Form and Instruction CMS-18F5
Interview/SSA Claim System (Modernized Claims System (MCS)/Consolidated Claim Experience (CCE)) Modified 460206 115052 0 Form and Instruction CMS-18F5
Total burden requested under this ICR: 1601967 400492 0  
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