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Request a Duplicate Form 1095-A

‚ÄčComplete the form below to request a duplicate 1095-A Form. All fields are required.

Note: You may be able to access your Form 1095-A through your online account.

‚ÄčIf you need immediate assistance, call our Contact Center at 651-539-2099 (855-366-7873 outside the Twin Cities).