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Form #
CMS L564
Form Title
REQUEST FOR EMPLOYMENT INFORMATION
Revision Date
2014-02-12
O.M.B. #
0938-0787
O.M.B. Expiration Date
2016-09-30
CMS Manual
Special Instructions
Return the completed form to your local Social Security field office. If you have questions, please contact Social Security. 1-800-722-1213