The Qira Agency Emina Qira
The Qira Agency 📞 201-446-8302
ACA Marketplace

Consent to Assist Applying

Emina Qira  ·  The Qira Agency

1

Consent to Assist

  • Gives me permission to view your information and help you shop for and apply for ACA Marketplace coverage
  • Required before I can search plans or submit an application on your behalf
  • You can withdraw this consent at any time, for any reason
Needed once per plan year
2

Acknowledgement of Eligibility

  • Confirms you've reviewed your application and the eligibility results are accurate
  • Required after your application is submitted and eligibility is determined, before I can complete enrollment
  • Federal rules require this confirmation be documented for every application
Needed once per application
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What happens when you sign: Submitting either form opens a pre-filled email in your device's mail app, addressed to me, with your typed signature, the date, and the exact language you agreed to. Sending that email is what creates your dated, documented record — so please make sure it actually sends. If your device doesn't open email automatically, call or text me and I'll get you a form another way.

Questions about either step, or ready to get started?

Let's Talk — 201-446-8302