testing page Blank Form (#5)Are you applying for coverage in one of the following states? NC SC FL GA TX TN OH AL MO MS VA LA Yes NoWhich qualifying event has occurred for you to have coverage on the 1st of the month? ( you will have to provide proof once your enrollment is complete) Move states Addition to Family Recently release from incarceration How many people need coverage? 1 2 3+Do you claim another on your tax return Covered Multiple HH CoveredEmailEmailSubmit Form