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Are you inquiring about yourself or a child?
Do you currently have insurance?
Do you have children (dependents) without insurance?
Have you had insurance within the last year?
You may be eligible for free or low cost state benefits - what is your yearly household income?
$0 - 9,999
$10,000 - 19,999
$20,000 - 29,999
$30,000 - 39,999
$40,000 - 49,999
$50,000 - 59,999
What is your primary mode of transportation?
What is your primary language?
Do you have internet access at home
Can a specialist contact you to help you get benefits?