Request Form: Organizational Template Comment on Proposed Changes to the Rule Implementing the Health Care Rights Law Impacting Older Adults (Section 1557 of the ACA)
Please complete the required sections below. Upon submitting this form you will receive a message that will contain a link to access the template.
Sign in to Google to save your progress. Learn more
Name (First, Last) *
Contact email *
Organization's name *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Justice in Aging. Report Abuse