Employment Information Document with Insurance Information

Pay stubs and W-2 forms are commonly used as proof of employment. Your employer may write a verification letter or use an automated verification service to confirm your job title, employment history, and salary information.

Form CMS-L564 is an employment information form from the Social Security Administration (SSA). It's used in conjunction with Form CMS-40B when you apply for Medicare part B during a special enrollment period (SEP). One portion is completed by you and the other is completed by your employer or your spouse's employer.

Enter the employee's last name, first name, middle initial and select the correct citizenship/immigration number in the Employee Info from Section 1 area at the top of Section 2. Ensure that any document your employee presents is original and on the Lists of Acceptable Documents or is an acceptable receipt.

This is for people who live permanently in the United States. Synonymous terms for immigrant status are: Permanent Resident, immigrant, green card holder, and resident alien. Gaining immigrant status can be a lengthy and complex process that requires close consultation with an immigration attorney.

Enter the number that correlates with the citizenship or immigration status box the employee selected in Section 1. Enter the document title, issuing authority, document number, and the expiration date from the original documents the employee presented.

The green card number also known as the receipt number or the permanent resident number is located on the bottom of the back of the card, in the first line of a long string of 90 characters.

Form I-9, officially the Employment Eligibility Verification, is a United States Citizenship and Immigration Services form. Mandated by the Immigration Reform and Control Act of 1986, it is used to verify the identity and legal authorization to work of all paid employees in the United States.