- Form #
- CMS 18F
- Form Title
- APPLICATION FOR HOSPITAL INSURANCE (English / Spanish)
- Revision Date
- 02/01/1991
- O.M.B. #
- 0938-0251
- O.M.B. Expiration Date
- 03/31/2014
- CMS Manual
- N/A
- Special Instructions
- You must either visit or contact the Social Security Administration to obtain this form. 1-800-772-1213
