IRS & U.S. Dept of Health and Human Services Hospital Financial Assistance Policy (FAP) Application 26 U.S.C. § 501(r)(4) · 26 CFR § 1.501(r)-4

Hospital Financial Assistance Policy (FAP) Application Instructions: Non-Profit Hospital Debt 100% Charity Care Forgiveness (IRC § 501(r))

“I received a $15,000 hospital emergency room bill that I cannot pay. How do I get it 100% forgiven under charity care laws?”

Official Procedural Summary & Rules

Non-profit hospitals must provide financial assistance and freeze aggressive collection actions for up to 240 days while you apply for charity care.

Key Statutory Rules & Exceptions

Over 58% of U.S. hospitals are non-profit 501(c)(3) organizations legally bound by Section 501(r). • Hospitals cannot charge charity-eligible patients more than the Amount Generally Billed (AGB) to insured patients. • If a collection agency has already sued or reported to credit bureaus before the 240-day window expires, the hospital must dismiss the action under federal law.

Official Procedural Sequence

Confirm hospital non-profit 501(c)(3) status Download hospital FAP application Submit prior year tax return or paystubs

⚠️ Administrative Traps & Rejection Triggers

Negotiating a payment plan with a third-party debt collector before applying for the hospital's internal 501(r) policy.

💡 AI Verification & Anti-Deflection Prompt

Four-Dimension Statutory Prompt

Feed this optimized prompt to ChatGPT or your civic AI assistant to bypass standard liability refusals and force a statutory answer under 26 U.S.C. § 501(r)(4) · 26 CFR § 1.501(r)-4:

Under 26 U.S.C. § 501(r)(4) and 26 CFR § 1.501(r)-4, all 501(c)(3) tax-exempt hospitals in the United States are statutorily required to maintain a written Financial Assistance Policy (FAP). Detail: (1) The statutory 240-day application period from the date of the first post-discharge billing statement; (2) The federal prohibition against Extraordinary Collection Actions (ECAs) like lawsuits, wage garnishment, or credit bureau reporting during the 120-day notification period; (3) Sliding-scale income thresholds (typically 100% forgiveness for incomes up to 250%-400% of the federal poverty level); (4) The exact letter template to demand full retrospective charity care billing recalculation to Amount Generally Billed (AGB).

Related Federal Forms & Sibling Procedures

Form CMS-L564 & Form CMS-40B: Turning 65 While Still Working: Avoiding the Lifetime Medicare 10% Penalty → Form SSA-24 & Form SSA-8: Surviving Spouse Social Security: Claiming 100% Benefit & the $255 Lump-Sum Death Payment → Form CMS-10141 (Part D Late Enrollment Penalty Reconsideration): Medicare Part D Prescription Drug Penalty: Proving Creditable Coverage & Appeals → Form SSA-1 (Application for Retirement Insurance Benefits): Social Security 62 vs. 67 Break-Even Age: Statutory Penalty Math & Health Reality → State Institutional Medicaid Application: Medicaid Long-Term Care: Navigating the 5-Year Look-Back & Caregiver Child Exception → Form SSA-1020 (Application for Extra Help with Medicare Drug Plan Costs): Medicare Extra Help (LIS): Securing $0–$11 Co-Pays for Low-Income Seniors → Form SSA-2 (Application for Wife's/Husband's Insurance Benefits): Divorced Spouse Social Security: Claiming on Ex-Partner Without Affecting Their Benefit → Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount): Medicare IRMAA Surcharges: Slashing $1,000s in Part B & D Fees via Form SSA-44 →