How to use or fill out Application forms for individuals - marketplace cms
- Click ‘Get Form’ to open it in the editor.
- Begin with Step 1: Tell us about yourself. Fill in your first name, middle name, last name, and suffix. Provide your home address, city, state, ZIP code, and county. If you have a different mailing address, include that as well.
- Next, provide your daytime and evening phone numbers. Indicate if you wish to receive information via email and specify your preferred language.
- Answer whether you need health coverage for yourself. If yes, complete the subsequent fields including Social Security Number (SSN), sex, date of birth, and citizenship status.
- Proceed to Step 2: List anyone else who needs health coverage by filling out their details similarly as you did for yourself.
- Continue through Steps 3 and 4 regarding American Indian/Alaska Native status and agreement & signature sections respectively.
- Finally, review all entries for accuracy before mailing the completed application to the specified address.
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