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Checklist: Apply for hospital financial assistance

Use this to apply and keep track. Rules differ by hospital, so also follow the instructions on the application.

Use your browser's print option, or the Print button. Sources and dates print too.

Get the forms

The financial assistance policy
The plain-language summary of the policy
The application form
The list of doctors and groups the policy covers
A copy in your language, if you need one

Gather papers

Recent pay stubs or other proof of income
Your most recent tax return, if you filed one
Benefit letters, such as unemployment or Social Security
A short signed note if you have no income
Your bills and account numbers

Send and track

Answer every question and sign the form
Make a copy of everything you send
Send it in a way you can track, or get a receipt
Write down the date sent and who received it
Ask the billing office to pause collections while they decide

After you apply

Reply quickly if they ask for more information
Get the decision in writing
If approved, check the new bill and ask about any refund
If turned down, ask for the reason and how to ask again

Related

This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.

Review status: Draft. Version 1. Sources retrieved: October 14, 2026.

Sources

Financial assistance policies (FAPs) Internal Revenue Service. Applies to: current page; regulations effective for years beginning on or after 2015-12-29. Published or updated: Unknown. Retrieved: November 5, 2026.
Billing and collections (Section 501(r)(6)) Internal Revenue Service. Applies to: current page; final regulations under section 501(r). Published or updated: Unknown. Retrieved: November 5, 2026.