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.2016 ACA Transitional Reinsurance Program Annual Enrollment Contributions
Description: Please use this form ONLY to submit your 2016 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program. ACH Company ID = 7505008016 and Company Name = USDEPTHHSCMS. Please email reinsurancecontributions@cms.hhs.gov if you need to submit your Previous Year's ACA Transitional Reinsurance Program Annual Enrollment Contributions form and contributions.
Form Number: ACA 2016
OMB Number: 0938-1155, 0938-1187
2014 ACA Transitional Reinsurance Program Annual Enrollment Contributions
Description: Please use this form ONLY to submit your 2014 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program.... ACH Company ID = 7505008015 and Company Name = USDEPTHHSCMS. Please use the Current Year ACA Transitional Reinsurance Program Annual Enrollment Contributions form to submit your Current Year contributions.
Form Number: ACA
OMB Number: 0938-1155, 0938-1187
2015 ACA Transitional Reinsurance Program Annual Enrollment Contributions
Description: Please use this form ONLY to submit your 2015 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program. ACH Company ID = 7505008015 and Company Name = USDEPTHHSCMS. Please email reinsurancecontributions@cms.hhs.gov if you need to submit your Previous Year's ACA Transitional Reinsurance Program Annual Enrollment Contributions form and contributions.
Form Number: ACA 2015
OMB Number: 0938-1155, 0938-1187
IRS Federal Excise Tax (FET) Exemption Agreement User Fee
Description: This form is used to pay the user fee applicable to any foreign insurer or reinsurer wishing to enter into a closing agreement under Rev. Proc. 2003-78, 2003-2 C.B. 1029. The stated user fee is in accordance with Appendix A of Rev. Proc. 2003-1, or any successor procedure.
Form Number: IRS FET Exemption Agreement User Fee

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