Please complete census for your group only if you have less than 50 employees. Please include all eligible, full-time employees.

Please complete the attached census entirely and be sure to include all information (zip codes, dependents names, gender, date of birth).

Step 1:

Download the Excel file.

Download ACA Census

Download ACA Census

Step: 2:

Complete the Excel file.

Step 3:

Save Excel file as .xlsx (CompanyName-Date-ACAForm.xlsx)

Step 4:

Complete the form below.

Step 5:

Upload Excel file to form.

Step 6:

Submit form with uploaded Excel file.

The Jordan Insurance Group Census

  • Please complete the census form by downloading the file in Step 1. Once complete, save the file as a .xlsx file. Example of file name: CompanyName-Date-ACAForm.xlsx