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Get Marketplace Appeal Request Form

Hts (OEOCR) 7500 Security Boulevard, Room N2-22-16 Baltimore, MD 21244-1850 Attn: CMS Alternate Format Team Choose an authorized representative • You have the right to choose an authorized representative to help you with your appeal. This is a trusted person who has your permission to talk with us about your appeal, see your information, and act for you on matters related to your appeal, including getting information about you and signing your appeal request on your behalf. • To appo.

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  3. Fill the blank areas; involved parties names, places of residence and phone numbers etc.
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  5. Include the day/time and place your electronic signature.
  6. Click Done after double-examining all the data.
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