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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
.