Form CMS-L564. Request for Employment Information

Form CMS-L564 - Request for Employment Information serves as a request for employment information and is typically required when individuals are applying for Medicare Part B based on their current employment status. It plays a crucial role in determining eligibility for Medicare Part B, which provides medical insurance coverage.

For instance, if you are eligible for Medicare Part B due to your current employment, you would use this form to provide necessary employment details. The form's purpose is to gather accurate employment information to assess eligibility for medical coverage.

The parties involved include the individual applying for Medicare Part B, their employer, and the Social Security Administration. The form is structured with sections for the applicant's information and the employer's information, including a certification section for the employer to complete.