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How do I fax a CMS L564 form?

You can also fax your enrollment forms and evidence of employment and health coverage to your local Social Security office. You can find your local Social Security office by clicking “SSA Office Locator” under the “Related Links” section below. Your employer doesn’t need to sign Section B of the CMS L564 form. ...

Do I need to sign Section B of the CMS L564 form?

Your employer doesn’t need to sign Section B of the CMS L564 form. State “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS 40B form or the online application. Visit faq.ssa.gov or call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778) for more information. ...

Who must fill out the Medicare form L564?

The first section of the Medicare Form CMS-L564 must be filled out by an individual who wishes to sign up for Medicare Part B - the employee or the employee's spouse: Record the name and social security number of the employee. The second section of the CMS-L564 Form is to be filled out by the employer: ...

How to fill out cms-l564?

The following tips will help you fill out CMS-L564 quickly and easily: Open the form in our full-fledged online editor by clicking on Get form. Fill in the requested boxes that are marked in yellow. Press the arrow with the inscription Next to jump from one field to another. Use the e-signature tool to e-sign the document. Put the relevant date. ...

How do I download a cms-l564 printable version?

You can download a CMS-L564 printable version through the link below. The first section of the Medicare Form CMS-L564 must be filled out by an individual who wishes to sign up for Medicare Part B - the employee or the employee's spouse: Record the name and social security number of the employee. ...