CMS Part A Application Form – Fillable PDF

The CMS Part A Application Form (CMS‑18F5) is the official document used to enroll in Medicare Hospital Insurance. Whether you’re applying for the first time or updating your information, a fillable PDF makes the process fast, accurate, and paper‑free.

What Is the CMS Part A Application Form?

This form collects personal, citizenship, and employment data required by the Centers for Medicare & Medicaid Services (CMS) to determine eligibility for Part A benefits. It is a federal form, and the information you provide is protected under U.S. law.

Key Features of Our Fillable PDF

• Interactive fields that auto‑save as you type
• Built‑in validation to reduce errors
• One‑click PDF download from Formize
• Secure, browser‑based filling – no extra software needed

How to Complete the Form Online

Follow the simple steps below to fill out the CMS Part A application directly in your browser.

Common Mistakes to Avoid

• Leaving required fields blank – the validator will highlight them.
• Entering outdated Social Security numbers.
• Using an unofficial PDF version – always use the CMS‑approved file linked here.

Where to Submit Your Completed Form

After saving the completed PDF, you can mail it to your local Social Security office or upload it through the CMS portal. Keep a copy for your records.