Printable blank Request for Employment Information CMS-L564

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What Is Form CMS-L564?

Form CMS-L564 is an important blank that’s used for validating your workplace and group health insurance needed for acquiring Medicare part B within a Special Enrollment Period.

What I Need Form CMS-L564 for

  • to apply for Medicare in a SEP;
  • to confirm your group health insurance related to your current workplace;
  • to validate your overall qualification for registration in the aforementioned healthcare insurance program.

The fillable CMS-L564 Form, along with other tax-, finance-, healthcare-, and business-related forms can easily be found on PDFLiner. Download CMS-L564 for free, print it out, and complete it manually (if that’s your ultimate goal). Alternatively, fill the PDF out online and make the most of the PDFLiner wonderful file editing features.

How to Fill out Form CMS-L564

The form is a 3-page document that contains two fillable sections, along with all the necessary requirements and instructions regarding the completion process. If completing the PDF poses certain difficulties in your case, feel free to ask a pro to help you with it.

The fillable part of the document consists of 2 sections: A and B. The former is for you to sort out, while the latter is for your boss. Here’s what you’re going to need to indicate when filling out ‘your’ segment of the file:

  • your boss’s full name and where they live;
  • their social security number;
  • the same details about you.

When you’re through filling out ‘your’ part of the file, take it to your boss and ask them to fill out the rest. After that, submit the blank to your local Social Security office.

Organizations That Work With Form CMS-L564

  • The United States Social Security Administration.

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