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Form CMS-L564 (CMS-R-29 CMS-L564 (CMS-R-29 Request for Employment Information
Request for Employment Information
Form CMS-L564
Request for Employment Information (CMS-R-297)
OMB: 0938-0787
OMB.report
HHS/CMS
OMB 0938-0787
ICR 201308-0938-009
IC 8554
Form CMS-L564 (CMS-R-29 CMS-L564 (CMS-R-29 Request for Employment Information
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0787 can be found here:
2023-05-31 - Extension without change of a currently approved collection
2020-03-24 - Reinstatement without change of a previously approved collection
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File Type
application/pdf
File Title
Scan-to-email
Author
Copier User
File Modified
2013-03-14
File Created
2013-03-14
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