Form CMS-L564: Request for Employment Information (Spanish)

Form CMS-L564: Request for Employment Information (Spanish): FAQs

  • Form CMS-L564 is a form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application.

  • You are only responsible for filling out the first section of the form, and your employer is responsible for filling out the second part as well as sign at the bottom.

Edit, Sign, Print or Download Employment Forms

This Employment Forms is fillable and printable via our secure online PDF form editor.Click here to edit Form CMS-L564: Request for Employment Information (Spanish) now.If this is not the form you are looking for scroll down to search for other official Employment Forms

Get Form CMS-L564 (SP) now
img
Looking for something else? Choose from over 800 document templates here.