Request for Employment Information, CMS-L564


(4.9 / 5) 72 votes
Request for Employment Information, CMS-L564 - Thumbnail

Get your Request for Employment Information CMS-L564 in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

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

CMS-L564 Screenshot

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. 

CMS-L564 - Screenshot 2

Organizations That Work With Form CMS-L564

  • The United States Social Security Administration.

What people say

  • Fred Walters
    Now that I’ve switched from Word to PDFLiner, I save lots of time processing and digitally distributing tons of billing forms, work orders, forecast reports, and invoices. In addition to this, thanks to PDFLiner, we’ve significantly minimized our paper consumption. Excellent tool that helps me cope with my business workflow faster and easier.
  • Peter Scheffel
    Self-employed attorney
    PDFLiner allows me to streamline the processes of generating and managing legal documents, as well as collecting electronic signatures for all my contracts and agreements. I like that I can customize forms on the go and access PDFLiner from all my gadgets. No more printing or scanning! That’s just brilliant!
  • Lisa Matthews
    University student
    When you’re a student, you deal with PDFs a lot… Newsletters, various worksheets, official forms you need to fill in and sign, etc… To me, filling out a PDF form used to be among the trickiest and most time-consuming things ever. But then a friend of mine introduced me to PDFLiner, and oh my God, my life has changed since then. It’s easy to use and has so many great features. Just awesome, I love it!
Fillable online Request for Employment Information CMS-L564
(4.9 / 5) 72 votes
Please, wait...
We use unpersonalized cookies to keep our site working and collect statistics for marketing purposes. By continuing to use this site, you consent to this policy. Learn more