If a person wishes to file for HI only, have the person (or the person's representative) file the same application e as if filing for the monthly benefit on which HI eligibility is based. Where a paper application is required:

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  Change the title of the application to “Application for Hospital Insurance.”

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  Delete that portion of the heading which states that the application is an application for Title II benefits.

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  Add to the “Remarks” section the following statement: “I understand this application will be effective for Medicare entitlement only. I also understand that I must file a separate application when I wish to establish entitlement to monthly social security benefits.”

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  Have the applicant complete only those items on the application which relate to eligibility for monthly Title II benefits (i.e., do not have the applicant complete items such as those relating to non-service months).

Obtain proof of age and verify that the individual is insured for Retirement Insurance Benefits (RIB).

If the number holder (NH) is not filing for monthly benefits for self , obtain proof-of-age and evidence of insured status for the NH. Also, if the NH is under age 62 and eligible for, but not entitled to Disability Insurance Benefits (DIB), obtain evidence of disability.

For the applicant, obtain proof-of-age and insured status and, as appropriate, evidence of relationship, dependency, support, and disability (in the unusual case where claimant is 65 or over and eligible for Childhood Disability Beneficiary (CDB)).

For the NH, obtain proof of death and evidence of insured status.

For the applicant, obtain proof-of-age and insured status and, as appropriate, evidence of relationship, dependency, support, and disability.