Form CMS-L564, also known as the Request for Employment Information form is used to verify employment-based health insurance coverage when applying for Medicare. This form is required when applying for Medicare in a Special Enrollment Period or when signing up for Medicare Part B after age 65. The purpose of the form is to prove to the government you were eligible to delay Medicare enrollment without a penalty because you had health insurance through your employer. As the applicant, you complete Section A and the employer completes Section B. Once completed, you then upload it to your online Medicare application (at the link provided below). A Social Security representative may contact you with questions about the information on the form.