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Consumer, we are collecting your name and/or email address to contact you, in order to give you a call and provide you with marketplace or healthcare access information. Your information will only be disclosed to a certified Navigator in order to call you using the information. We will not share the information with anybody else. If you proceed with enrollment you will be provided a written copy and the opportunity to consent to services. Your information will be secured at all times. The collection of this information is voluntary under applicable law(s). If you choose not to share your information, you can call us directly for services and support.

PLEASE SEE BELOW ON INFORMATION ON HOW TO FILE A COMPLAINT WITH CMS IN RELATIONSHIP TO THE INFORMATION COLLECTED:

U.S. Department of Health & Human Services

Office of Inspector General

ATTN: Mandatory Grant Disclosures, Intake Coordinator

330 Independence Avenue, SW, Cohen Building

Room 5527

Washington, DC 20201

Fax: (202) 205-0604 (Include “Mandatory Grant Disclosures” in subject line) or

Email: MandatoryGranteeDisclosures@oig.hhs.gov