№ files_lp_3_process_9_51480
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Character count: 3574
File size: 29 KB
Federal administrative attestation form requiring applicants to acknowledge Marketplace enrollment terms, tax credit conditions, income verification procedures, automatic coverage termination rules, and legal liability for false statements under penalty of perjury.
Country:
United States
Program:
Health Insurance Marketplace
Subject:
Enrollment consent and premium tax credit eligibility
Tax Year Referenced:
2024
Related Tax Year Reconciliation:
2023
Document Type:
Attestation and consent form
Issuing Authority:
Centers for Medicare & Medicaid Services (CMS)
Legal Basis:
Federal income tax regulations and Marketplace regulations
Required Action:
Signature and agreement selection
Validity Period:
Annual requirement with five-year income data authorization option
Contact Information:
Marketplace Call Center 1-800-318-2596 (TTY 1-855-889-4325)
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2011
Region / City:
Global
Subject:
Bing Search API, Azure Marketplace, Subscription Management
Document Type:
FAQ
Organization / Institution:
Microsoft
Author:
Microsoft
Target Audience:
Developers, Information Workers, Businesses using Bing Search API
Effective Period:
N/A
Approval Date:
N/A
Date of Changes:
N/A
Year:
2013
Region / City:
New South Wales, Australia
Subject:
Textiles and Design
Document Type:
Educational Resource
Author:
NSW Education Standards Authority (NESA)
Target Audience:
Teachers and Students
Period of Use:
2013 and onwards
Approval Date:
2013
Date of Changes:
Not specified
Year:
2017
Region / City:
United States
Topic:
Healthcare, Insurance, State-based Marketplaces
Document Type:
Approval Request
Organ / Institution:
Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO)
Author:
Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO)
Target Audience:
State-based Exchange Administrators, Insurance Program Managers
Period of Validity:
Until December 31, 2017
Approval Date:
December 7, 2017
Amendment Date:
Not specified
Year:
2024
Region / City:
Illinois
Theme:
Health insurance, public sector project
Document Type:
Request for Proposals (RFP)
Organization / Institution:
Illinois Department of Insurance
Author:
Illinois Department of Insurance
Target Audience:
Potential Offerors with experience in project management and public sector system implementations
Period of Action:
Plan Year 2024 to Plan Year 2026
Approval Date:
N/A
Date of Changes:
N/A
Note:
Year
Document Type:
Chapter
Year:
2013
Effective Date:
October 1, 2013
Topic:
Health Insurance, Affordable Care Act
Document Type:
Employer Notice / Letter
Organization:
[INSERT COMPANY NAME]
Audience:
Employees not offered employer-sponsored insurance
Reference:
U.S. Department of Labor requirements
Links:
http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf
, http:
//kff.org/interactive/subsidy-calculator/
, https:
//www.healthcare.gov/
Year:
2025
Region / City:
United Kingdom, British Overseas Territories, Crown Dependencies
Subject:
Government procurement framework
Document Type:
Framework Agreement
Organization:
Government of the United Kingdom
Author:
Not specified
Target Audience:
Contracting Authorities, Public Sector Organizations
Period of validity:
Until 28 November 2025
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2023
Region / City:
United States
Theme:
Health Insurance Marketplace, ACA, Reporting Requirements
Document Type:
Regulatory Report
Agency / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
State-based Marketplaces (SBMs), CMS
Period of Validity:
Annual submission
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2013
Date:
May 23, 2013
Region / State:
Arkansas, United States
Subject:
Health insurance marketplace development and implementation
Document Type:
Government report
Institution:
Arkansas Insurance Department
Division:
Health Benefits Exchange Partnership Division
Recipient Body:
Joint House and Senate Public Health Committees
Programs Referenced:
Arkansas Health Connector; State Partnership Marketplace (SPM)
Federal Partners:
U.S. Department of Health and Human Services (DHHS); Centers for Medicare & Medicaid Services (CMS); Center for Consumer Information and Insurance Oversight (CCIIO)
Associated Legislation:
Healthcare Independence Act of 2013; Act 1439 of 2013
Key Activities:
Consumer assistance program development; Qualified Health Plan certification process; outreach and education campaign; marketplace implementation timeline
Geographic Scope:
State of Arkansas, United States
Coverage Period:
January 2013 – March 31, 2014
Open Enrollment Period:
October 1, 2013 – March 31, 2014
Organizations Involved:
First Data Government Solutions; Arkansas Department of Higher Education; Arkansas Association of Two Year Colleges; Public Consulting Group; Mangan Holcomb Partners
Target Groups:
Uninsured residents, families, and small business employees in Arkansas
Year:
2025
Region / City:
Washtenaw County
Topic:
Native Plants, Conservation, Habitat Restoration
Document Type:
Press Release
Organization:
Washtenaw County Conservation District
Author:
Doug Reith
Target Audience:
General Public
Event Date:
June 7, 2025
Date of Issue:
May 5, 2025
Sponsors:
Garden Juju Collective, Gateway Farm, Project Grow, PlantWise, Michigan Wildflower Farm, Michigan Lakes and Streams Association, Huron River Chain of Lakes Association, Bendy Stem Farm, Washtenaw County Parks & Recreation Commission, Wild Ginger Woodlands, Ann Arbor Farm & Garden, Legacy Land Conservancy
Contextual Description:
Public announcement about the Native Plant Expo & Marketplace event in Washtenaw County, offering free milkweed plants and native plant sales, while promoting conservation education and biodiversity.
Year:
2026
Region / City:
-
Topic:
Trauma Care, EMS, Hospital Resources
Document Type:
Checklist
Organization / Institution:
-
Author:
-
Target Audience:
Healthcare professionals involved in trauma care
Period of Validity:
-
Approval Date:
-
Date of Changes:
-
Publication Date:
October 2024
PCI DSS Version:
4.0.1
Type:
Self-Assessment Questionnaire (SAQ)
Applicability:
E-commerce merchants using third-party payment processors, not storing cardholder data electronically
Target Audience:
E-commerce merchants
Document Changes:
Detailed revision history from 2014 to October 2024, including updates to align with PCI DSS versions 3.0–4.0.1
Appendices:
A, A1, A2, A3, B, C, D
Publication Date:
January 2025
PCI DSS Version:
4.0.1
SAQ Revision:
1
Document Type:
Self-Assessment Questionnaire and Attestation of Compliance
Standard:
Payment Card Industry Data Security Standard
Issuing Organization:
PCI Security Standards Council
SAQ Type:
SAQ A
Applicable Entities:
Merchants
Payment Channels:
E-commerce; Mail/Telephone-Order
Data Handling Scope:
Fully outsourced account data processing
Applicability Exclusions:
Face-to-face channels; Service providers
Primary Audience:
Card-not-present merchants using PCI DSS compliant third-party service providers
Document Sections:
Assessment Information; Self-Assessment Questionnaire A; Validation and Attestation Details; Appendices
Compliance Confirmation:
Third-party service providers PCI DSS compliance confirmed by merchant
Year:
2023
Region/City:
Wisconsin, USA
Topic:
Provider Certification and Compliance
Document Type:
Form
Organization/Institution:
Community Care, Inc.
Author:
Unknown
Target Audience:
Health service providers, including staff members and operators
Effective Period:
Ongoing
Approval Date:
N/A
Date of Changes:
N/A
Note:
Provider Name
Staff Job Description:
Yes/No
Training Plans:
Yes/No
Staff Competency Validation:
Yes/No
Staff Qualifications Documentation:
Yes/No
Training for Working with Frail Elders/Disabled:
Yes/No
Annual Compliance Training:
Yes/No
Staff Disease Screening:
Yes/No
Criminal and Caregiver Background Checks:
Yes/No
Excluded Individuals and Entities:
Yes/No
Transportation Providers:
Yes/No
Civil Rights/Affirmative Action Compliance:
Yes/No
Year:
2021
Region / City:
Canada
Subject:
Identification Verification, Anti-Money Laundering, Loan Documentation
Document Type:
Form
Organization / Institution:
THINK Financial
Author:
THINK Financial
Target Audience:
Borrowers, Guarantors, Solicitors, Notaries, Signing Agents
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Modifications:
Not specified
Country:
Pakistan
Issuing authority:
Ministry of National Health Services, Regulations & Coordination
City:
Islamabad
Document type:
Application form with specimen affidavit
Subject area:
Attestation of professional documents
Target professions:
Doctors, paramedics, pharmacists, homeopathics, tabibs, physiotherapists
Purpose:
Attestation of documents for overseas employment
Applicant information required:
Personal, educational, professional, and overseas employment details
Required attachments:
Attested copies of degrees, certificates, CNIC, passport, affidavit
Affidavit requirement:
Stamp paper Rs. 20/-
Applicable employment context:
Overseas job placement
Administrative location:
Pak Secretariat, Kohsar Block
Note:
Year
Topic:
Minimum Staffing Requirements for Specialty Out-Of-Home Treatment Services for Youth
Document Type:
Attestation
Organ/Institution:
New Jersey Department of Children and Families
Target Audience:
Providers of Specialty Out-Of-Home Treatment Services for youth
Year:
2014
Region / City:
Global
Topic:
Payment Application Data Security
Document Type:
Attestation
Organization / Institution:
PCI SSC
Author:
Payment Application Qualified Security Assessor (PA-QSA)
Target Audience:
Payment Application Vendors, PA-QSA
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified