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New Health Insurance Marketplace Coverage Options and Your Health CoverageForm Approved OMB No. 12100149 (expires 1312017)PART A: General Information When key parts of the health care law take effect

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Start by providing your personal details such as your full name, date of birth, and contact information.

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Part A general information is a section of a form that includes basic details about the entity or individual filling out the form.

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Any entity or individual required to submit the form will need to complete and file Part A general information.

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Part A general information is usually filled out by providing accurate and up-to-date details requested in the form.

What is the purpose of part a general information?

The purpose of Part A general information is to establish the identity and contact information of the entity or individual submitting the form.

What information must be reported on part a general information?

Information such as name, address, contact details, and other basic identifying information may need to be reported on Part A general information.

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