Obamacare Enrollment - Only Four Short Steps STEP 1 : Tells Us About Yourself Priority Code (if you have one) * First Name Middle Name * Last Name and Suffix (if applicable) Resident Street Address City State -- Select -- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Phone Number Mobile Number * E-mail Address Do you want to get information about this application by email? YesNo Date of Birth (mm/dd/yyyy) Preferred Language Gender FemaleMale Are you US Citizien or US National? YesNo Social Security Number (no dashes) Do you somke? YesNo Are you pregnant? YesNo Do you have a physical, mental, or emotional health condition that causes limitations in activities (like bathing, dressing, daily chores, etc.) or live in a medical facility or nursing home? YesNo