Downloadable Forms

Helpful forms and documentation


Request for Employment Information Form (CMS L564)

This is used to verify employment for those signing up for Medicare after 65 due to being covered by an employer plan.

Medicare Part B Enrollment Form (CMS 40B)

This form is used by those who already have Medicare Part A, but not Part B, and they would now like to sign up for Medicare Part B.

Income Appeal Form (SSA 44)

This form is used to appeal the income figure Medicare is using for you to determine your Part B premium.