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 Below is the link to the ACA Short Form (This form is a short version of the Marketplace Application on healthcare.gov). A copy of the full version is available by clicking the Healthcare.gov link shown below.

Disclaimer of Warranties and Limited Liability
This web site is provided by the company on an “as is” and “as available” basis. The company makes no representations or warranties of any kind, express or implied, as to the operation of this site or the information, content, materials, or products included on this site. You expressly agree that your use of this site is at your sole risk. Any links to other web sites are provided as a courtesy. They are not intended to nor do they constitute an endorsement by the company of the linked materials.to the full extent permissible by applicable law, the company disclaims all warranties, express or implied, including, but not limited to, implied warranties of merchantability and fitness for a particular purpose. The company does not warrant that this site, its servers, or e-mail sent from the company are free of viruses or other harmful components. The company will not be liable for any damages of any kind arising from the use of this site, including, but not limited to direct, indirect, incidental, punitive, and consequential damages, even if the company is made aware of the possibility of such damages.
Certain state laws do not allow limitations on implied warranties or the exclusion or limitation of certain damages. If these laws apply to you, some or all of the above disclaimers, exclusions, or limitations may not apply to you, and you might have additional rights.

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