CMS-10555 SHOP Notices - Employer Survey

Attachment 2. SHOP Survey – Employer

OMB #: 0938-

Expiration Date:

*General note: Add SHOP Marketplace logo as header to all pages.

Learning about the SHOP Marketplace:

Enrollment:

SHOP Call Center:

SHOP payments:

Plan and benefits:

Customer demographics (optional):

What state(s) do you have SHOP coverage? *Check all that apply) (Drop down)

Resources/recommendations:

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