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1. www.cms.gov › cms-l564-request-employment-informationCMS-L564: Request for Employment Information | CMS

   www.cms.gov › cms-l564-request-employment-information

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   Ask your employer to fill out Section B. You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B). Then you send both together to your local Social Security office. Find your local office here: www.ssa.gov. GET HELP WITH THIS FORM. Phone: Call Social Security at 1-800-772-1213.

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     This is the most efficient and timely way for CMS to gather...

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     The COVID-19 public health emergency (PHE) ended at the end...

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     CMS is making available a series of RSS feeds and podcasts...

   • All Fee-For-Service-Providers

     A List of All Fee-For-Service Providers. Spotlights PrEP for...

   • Managed Care Appeals & Grievances

     Medicare health plans, which include Medicare Advantage (MA)...

   • Pre-existing Condition Insurance Plan

     The Affordable Care Act created the Pre-Existing Condition...

   • Health Care Financing Review

     This page serves as an archive of the Centers for Medicare &...

   • Coverage Gap Discount Program

     Since the Coverage Gap Discount Program began on January 1,...

2. www.cms.gov › Medicare › CMS-FormsREQUEST FOR EMPLOYMENT INFORMATION - Centers for Medicare &...

   www.cms.gov › Medicare › CMS-Forms

   Ask your employer to fill out Section B. You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B). Then you send both together to your local Social Security office. Find your local office here: www.ssa.gov. GET HELP WITH THIS FORM.

3. www.cms.gov › cms40b-application-enrollment-part-bCMS40B - Application for Enrollment in Part B | CMS

   www.cms.gov › cms40b-application-enrollment-part-b

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   This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare; During the General Enrollment Period (GEP) from January 1 through March 31 of each year

4. www.medicare.gov › basics › forms-publications-mailingsEnrollment Forms - Medicare

   www.medicare.gov › basics › forms-publications-mailings

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   To sign up for Part B in one of these situations, you’ll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time. Sign up for Part A & Part B using a Special Enrollment Period.

5. www.ssa.gov › medicare › sign-upSign up for Part B only | SSA

   www.ssa.gov › medicare › sign-up

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   Fill out the Application for Enrollment in Medicare Part B (CMS-40B) (PDF). If you are applying during the Special Enrollment Period, also fill out the Request for Employment Information (CMS-L564) (PDF).

6. www.medicare.gov › sign-up › ready-to-sign-up-for-part-a-part-bReady to sign up for Part A & Part B - Medicare

   www.medicare.gov › sign-up › ready-to-sign-up-for-part-a-part-b

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   Apply online to sign up for Part B if you already have Part A. Have the employer fill out form CMS-L564. Send the completed form to your local Social Security office by fax or mail.

7. www.hhs.gov › guidance › sitesAPPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE)...

   www.hhs.gov › guidance › sites

   This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: • During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare • During the General Enrollment Period (GEP) from January 1 through March 31 of each year