CMS-10466 Application Exemption - Hardships

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

Appendix A - Hardship-Exemption-Application (2)

OMB: 0938-1190

Document [pdf]
Download: pdf | pdf
Please open this document using Adobe Reader

.
You're seeing this message for one of two reasons: Because you're trying to open
this document in your web browser, or because you don't have the Adobe Reader
software needed for this type of document.
.
If you opened this document in your web browser:
• Minimize this browser window.
• Locate the document on your computer.
o If you don't know where the document is, look in your computer's
"Downloads" folder.
• Click on the document to open it using Adobe Reader.
.
If you opened this document from a location on your computer:
• You don't have an updated version of Adobe Reader software on your
computer.
• Visit http://get.adobe.com/reader to download it for free.
• After you install Adobe Reader, open the document again.


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

© 2024 OMB.report | Privacy Policy