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Social security medicare cms-l564 Form: What You Should Know

CMS L-64: Request for Employment Information — General Application (Social Security Number) The CMS-L564 form is used to submit data to the Social Security Administration to confirm your eligibility to be covered by Medicare and Social Security. You can use it to send to the social security administration, if you have questions or are facing an appeal based on your SSA eligibility information (e.g., if you submitted inaccurate data or had an appeal) The CMS-L564 form can also be used if you are applying for unemployment benefits, or you need proof you are the person you say you are. The CMS-L564 form can be used with your social security card, federal identification card, work permit, voter registration, or other federally issued documents. How to submit data. The CMS-L564 form is only used for people applying for health care programs for which SSA has received a Social Security number. How SSA will use this form. SSA will receive a copy of the form from the social security administration. Your employment history data will then be used in the following steps: 1) To verify your SSA eligibility 2) To help the social security administration determine if you can continue to receive benefits. Steps required To be approved to request a form CMS-L564, you must provide the following information: Your name and birthdate. A current (within three months) valid social security number. For example, if your current social security number is, your submission to SSA is for the CMS-L564. If your current social security number is, your submission to SSA is for Form CMS-L564 (Employment Approval Form). Note: Your social security number, date of birth, and your name and birthdate are confidential. You will not be able to submit an application for CMS-L564 unless you provide all the needed information. When submitting information for SSA to confirm your social security number: Enter the Social Security administration number or agency name as it appears on your social security card. You can enter this information in a few different ways. You can type it in when completing the online application, or you may want to send it as an attachment. Furthermore, you can also use the Social Security administration number link. Click on this link and complete the Social security number information.

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