Get the free Complete this application to apply for SHOP health coverage from your employer
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Com/ForSmallBusiness or call us at 877 453-9198. Para obtener una copia de este formulario en Espa ol llame 877 453-9198. Ca.gov or call 1-800-345-VOTE 8683. Para obtener una copia de este formulario en Espa ol llame 877 453-9198. It will not be used to decide what health insurance you qualify for. 24. Are you of Hispanic/Latino or Spanish origin OPTIONAL Mexican Mexican American Chicano Salvadoran Yes Puerto Rican No If yes check which one s Cuban Guatemalan Other Hispanic Latino or Spanish...
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