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Sole proprietor or disregarded entity owned by an individual

Federal income tax return, audited financial statements, or internally-generated financial statements submitted in their entirety:.

Internally-generated financial statements that substantiate operating revenues and expenses from patient care in 2019 Q1, Q3, and Q4 2020 Q3 and Q Q1.

A comprehensive list of all billing TINs under the filing TIN that provide patient care and are owned by the filing TIN that is applying.

Supporting documentation and information needed to complete an application will include:

Other services (e.g., foster care, developmental disability services).

Other outpatient clinics (e.g., urgent care, dialysis center).

Other ancillary services (e.g., chiropractors, speech and language pathologists, physical therapy, occupational therapy).

Nursing homes and skilled nursing facilities.

Inpatient behavioral facilities (e.g., inpatient rehabilitation facilities, long-term acute care hospitals, other residential facilities).

Home and community-based support (e.g., housing services, care navigators, case management).

Durable Medical Equipment (DME) suppliers.

Diagnostic services (e.g., independent imaging, radiology, labs).

Behavioral health providers (e.g., substance use disorder, counseling, psychiatric services).

HRSA will base payments on data already available to it using the Federal Office of Rural Health Policy definition of rural.ДЄny provider or supplier of health care, services, and support in a medical setting, at home, or in the community, including, but not limited to: Applicants do not need to verify whether their beneficiaries live in an area that meets the definition of rural. ARP Rural payments will be determined based on the amount and type of Medicare, Medicaid, and CHIP services provided by billing TINs to rural beneficiaries. In order to be considered for an ARP Rural payment, applicants must include any billing Tax Identification (TIN) owned by the applicant. Providers will apply for both programs in a single application. Eligible applicants can apply for the ARP Rural funds through the same Application and Attestation Portal that is available to apply for the Phase 4 General Distribution. What Is ARP Rural?ДЄRP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers funding will be available to providers who serve patients in these communities. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions. Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus.

Phase 4 and ARP Rural вЂ“ overview and portal demo.

Phase 4 and ARP Rural вЂ“ providing supporting documentation.

ARP Rural - Terms and Conditions (PDF - 222 KB).Phase 4 - Terms and Conditions (PDF - 213 KB).Stakeholder Toolkit Webpages | Stakeholder Toolkit (PDF - 1.19 MB).Provider Relief Fund and ARP Rural Payments Frequently Asked Questions (PDF - 564 KB).Fact Sheet - Complex Organizational Structures (PDF - 49 KB).For assistance, please email the Provider Relief Bureau at General Program Information * Note: Persons using assistive technology may not be able to fully access information in this file. Annual Revenues Adjustment Worksheet* (XSLX - 111 KB) | Read the instructions.Annual Revenues from Patient Care Worksheet* (XSLX - 433 KB) | Read the instructions.'How to Apply' Flow Chart (PDF - 70 KB).

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Application Instructions ( Download PDF file - 331 KB).

Provider Relief Fund Application and Attestation Portal.

Providers who have questions regarding technical issues in submitting applications may contact Resources Application Resources Providers with questions about the Phase 4 and ARP Rural application process should contact the Provider Support Line at 86 (for TTY dial 711). Further updates on payment determinations and timing are forthcoming. HRSA is working to swiftly review applications and determine payments. The deadline to initiate an application was Octoat 11:59 p.m., while the deadline to submit a completed application was Novemat 11:59 p.m. The application for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments has closed.