Federally-Facilitated Marketplace (Ffm) User Fee Adjustment Web Form Quick Startguide - Centers For Medicare And Medicaid Services Page 3

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FFM User Fee Adjustment Web Form Quick Start Guide
Figure 2: Select the Benefit Year
3 Contact Information Page
Once the 2016 Benefit Year has been selected, you will be directed to the Contact Information
Page. The Submitter and Alternate Contacts must be different.
Table 1: Contact Information Page
Step
Action
1
Enter the Submitter Contact information:
•
First Name
•
Last Name
•
Job Title
•
Email Address
•
Phone Number
•
Phone Extension (optional)
2
Enter the Alternate Contact information (must be different from the Submitter
Contact):
•
First Name
•
Last Name
•
Job Title
•
Email Address
•
Phone Number
•
Phone Extension (optional)
3
Select the Continue button.
You will be directed to the Organization Type page of the web form.
FFM User Fee Adjustment Web Form Quick Start Guide
3

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