Request for Employment Information
Form CMS-L564 (09-16).pdf
Medicare
Request for Employment Information
OMB: 3220-0082
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0082 can be found here:
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| File Type | application/pdf |
| File Modified | 2015-01-08 |
| File Created | 2015-01-08 |