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2017 - 2018 Hardship Exemption Application-2026
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- Click ‘Get Form’ to open the 2017 - 2018 Hardship Exemption Application in our editor.
- Begin by filling in your personal information in Section 1. Include your name, home phone number, mailing address, and service address. Indicate whether you are a homeowner or renter.
- In Section 2, answer the questions regarding any assistance you receive. Check 'Yes' or 'No' for each question and provide details as necessary.
- Proceed to Section 3 to list all household members. Fill in their names, birth dates, relationship to you, sex, disability status, and types of income. Ensure accuracy as this information is crucial for eligibility.
- In Section 4, sign and date the application to confirm that all provided information is true and complete. This step is essential for processing your application.
- Review the criteria in Section 6 to ensure you meet at least two conditions for exemption eligibility before submitting your completed form along with required documents.
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Related links
The Exchange must grant a hardship exemption to an applicant eligible for an exemption for at least the month before, the month or months during
May 14, 1992 The department may reduce the amount of response costs to be paid by a person by the amount that would create an undue financial hardship.
Hardship exemptions. You can qualify for this exemption if you had a financial hardship or other circumstances that prevented you from getting health insurance.Read more