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Click ‘Get Form’ to open the OMB NO 0938-0008 in our editor.
In Block 1, print your name as it appears on your Health Insurance Card, including your last name, first name, and middle name.
For Block 2, enter your Health Insurance Claim Number exactly as shown on your Medicare card and check the appropriate box for the patient’s sex.
In Block 3, provide your mailing address and telephone number. If this is a new address, check the corresponding box.
Describe the condition related to treatment in Block 4. Check 'Yes' or 'No' for questions regarding employment and other insurance coverage in Blocks 4b and 4c.
Complete Block 5 if you have additional medical coverage. Provide details about other insurance or state agency coverage if applicable.
Sign and date the form in Block 6. If unable to sign, follow instructions for a witness signature.
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The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form required by the Centers for Medicare Medicaid Services (CMS) of the U.S. Department of Health Human Services.
What is an OMB number 1545-0008?
OMB 1545-0008. Section 6051 of the Internal Revenue Code requires employers to furnish income and withholding statements to employees and to the IRS. Employers report income and withholding information on Form W-2. Forms W-2AS, W-2GU, and W-2VI are variations of the W-2 for use in U.S. possessions.
What does OMB No 1545 0008 mean?
a Employees social security number. OMB No. 1545-0008. This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.
What is the OMB number for the W-2?
All of the 2025 Forms W-2, W-2AS, W-2GU, W-2VI, W-3, and W-3SS have been updated to show the new OMB Number 1545-0029. In addition, updated correction Forms W-2c and W-3c were released in June of 2024. The forms have a revision date (Rev. 6-2024) to the right of the bold W-2c or W-3c.
Can I print IRS forms in black and white?
Forms 1040A, 1040EZ and 1040 substitute reproductions may be in black ink without the colored screening. The only exception to this rule is Form 1041-ES, which should always be printed with a very light gray shading in the color screened area.
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People also ask
What is OMB No 2126 0008?
This ICR is a request for the renewal of a mandatory collection.
What does the OMB number mean on a tax return?
OMB Numbers are form and information collection numbers assigned by The Office of Management and Budget. The Office of Management and Budget is the largest office within the Executive Office of the President of the United States.
Related links
HEALTH INSURANCE CLAIM FORM
APPROVED OMB-0938-0008. PO BOX 1407, CHURCH STREET STATION. NEW YORK NY 10008-1407. PICA. HEALTH INSURANCE CLAIM FORM. PICA. (APPROVED BY AMA COUNCIL ON MEDICAL
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