CMS-10466 Application Exemption - Hardships

Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions (CMS-10466)

Appendix A - Hardship-Exemption-Application (2)

Exemption Applications - Eligibility for Exemptions

OMB: 0938-1190

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File Typeapplication/pdf
File TitleHealth Insurance Marketplace - Application for a Hardship Exemption
SubjectHealth Insurance Marketplace, Application for Exemption, Shared Responsibility Payment for Individuals, Experienced Hardships
AuthorHealth Insurance Marketplace
File Modified2023-12-20
File Created2023-12-15

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