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cmsl564(cms-r-297)



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cmsl564(cms-r-297)

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Request for Employment Information – CMS

www.cms.gov

Form CMS-L564 (CMS-R-297) (0 9/1 6). 1. DEPARTMENT OF HEALTH AND
HUMAN SERVICES. CENTERS FOR MEDICARE & MEDICAID SERVICES.

application for enrollment in medicare part b – CMS

www.cms.gov

Form CMS-L564 ”Request for Employment Information” completed by your …
CMS-L564 with your Part B application. If you have …. the “Request for
Employment Information” form (CMS-L564/CMS-R-297) with your application.
The purpose of …

form cms-l564 (cms-r-297)

www.cms.gov

Form CMS-L564 (CMS-R-297) (0 9/1 6). 1. Formulario Aprobado. OMB No. 0938-
0787. DEPARTAMENTO DE SALUD Y SERVICIOS HUMANOS. CENTROS DE …

request for employment information – Social Security

secure.ssa.gov

Form CMS-L564 (04/10). U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES. CENTERS FOR MEDICARE & MEDICAID SERVICES. FORM
APPROVED.




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