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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

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 Company Name* How many total employees do you currently have?* How many members will be or are likely to be enrolling?* Upload Census File* 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