The Request for Employment Information Form CMS-L564 is a crucial document that individuals use when applying for Medicare coverage based on their current (or former) employment. This form serves as proof of prior employment or group health coverage in order to waive the late enrollment penalty for Medicare Part B. The purpose of the CMS-L564 form is to gather relevant employment details that substantiate an individual's eligibility for Medicare. It requires accurate information about the applicant's employment status, such as the name of the employer, dates of employment, nature of work performed, and the employer's signature or authorized representative. Additionally, this form acquires information about any group health plan coverage that the individual, their spouse, or a family member may have or have had. By submitting the Request for Employment Information Form CMS-L564, eligible individuals can avoid paying a higher premium for Medicare Part B. This form effectively demonstrates the existence of prior group health coverage, ensuring that individuals are not penalized for delayed enrollment. It is important to note that there may not be different types of CMS-L564 forms. However, variations in the content requested on the form might occur based on individual circumstances. The general purpose remains the same: to attain employment-related information in order to determine an applicant's eligibility and avoid late enrollment penalties associated with Medicare Part B.
Request For Employment Information Form Cms-l564
Description
How to fill out Employment Information Form?
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FAQ
You can complete form CMS-40B (Application for Enrollment in Medicare ? Part B [Medical Insurance]) and CMS-L564 (Request for Employment Information) online. You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office.
This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.
SECTION A: Employer's name: Write the name of your employer. Date: Write the date that you're filling out the Request for Employment Information form. Employer's address: Write your employer's address. Applicant's Name: ... Applicant's Social Security Number: ... Employee's Name: ... Employee's Social Security Number:
You need to contact your HR representative and inform them that the law requires them to sign the form and if they refuse not only will you be forced to sue, but you will report them to the Social Security Administration for investigation in refusing to comply with the federal regulations that the employer fill out the ...
