2024 Subsidy Update Form | Tailored BenefitsLLC

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2024 Subsidy Retention Form

Complete the form below to satisfy mandatory ACA compliance to maintain your subsidy for 2024.

First name

Last name

Email

Date of Birth

Phone (only required if requesting a call)

Address

2024 Subsidy Retention-Updates- Choose all that apply

Income- Projected for 2024

Household Size

Marital Status

Other

No Changes for 2024

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