Exemption Applications - Eligibility for Exemptions

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

OMB: 0938-1190

IC ID: 205753

Documents and Forms

Document Name Document Type
Form CMS-10466 Exemption Applications - Eligibility for Exemptions Form and Instruction
CMS-10466 Application Exemptions Shared Responsibility for FFM's Appendix C - Affordability-SBE-Exemptions-Application.pdf Form and Instruction
CMS-10466 Exemption Application - Shared Responsibility SBM's Appendix B - Affordability-FFM-Exemption-Application.pdf Form and Instruction
CMS-10466 Application Exemption - Hardships Appendix A - Hardship-Exemption-Application (2).pdf Form and Instruction