Form CMS L564 is used to provide employment information necessary for individuals applying for Medicare Part B under a Special Enrollment Period. It is particularly important for those who are still employed or have a spouse who is employed, as it helps verify health insurance coverage under a group health plan.

Individuals applying for Medicare Part B under a Special Enrollment Period who need to verify employment and group health plan coverage.

It is used to request employment information for Medicare Part B applications under a Special Enrollment Period.

It must be completed by individuals applying for Medicare Part B who need to verify employment and group health plan coverage.

It is not required for individuals without current employment or group health plans.

The form is typically submitted to the Social Security Administration; check with the SSA for submission options.