The U.S. Department of Health and Human Services (HHS) is making $25.5 billion in new provider relief funding available to healthcare providers. The Health Resources and Services Administration (HRSA), an agency of HHS, administers the provider relief programs on behalf of HHS. HRSA is using a single application portal to make $8.5 billion in American Rescue Plan Act (ARP) Rural payments and $17 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments.
These instructions will guide you through how to apply. View a sample application form (PDF – 178 KB).
Please note that payments are subject to the availability of funds.
The applicant must adhere to the requirements following:
- Filing TIN and Subsidiaries: In general, applications must be submitted at the parent or filing tax identification number (TIN) level (i.e., the entity that files federal income taxes). In some cases, entities that are within a parent entity’s filing TIN may wish to apply. These entities must include additional requirements at Field 17 Annual Revenues from Patient Care Worksheet and Field 18 Organizational Structure Documentation. HRSA will review these exceptions on a case-by-case basis.
- Multiple Applications: Applicants must not submit multiple applications with the same filing TIN(s). HRSA will not pay duplicate providers.
- Comprehensive Listing of Billing and Subsidiary TINs: Applicants must include all billing TINs under the filing TIN that provide patient care. Applicants must include an exhaustive list of TINs and must ensure that all TINs included in the application belong to the filing TIN that is applying. HRSA will calculate the ARP Rural and a portion of Phase 4 payments based on the submitted billing TINs. Failure to include an exhaustive list of billing TINs that provide patient care will affect the amount of the applicant’s ARP Rural payment and Phase 4 bonus payment.
Failure to adhere to these requirements and the following instructions may result in HRSA deeming your application ineligible for payment.
Please review the following Technical Assistance documents prior to applying.
- Sample Application Form (PDF – 178 KB)
- “How to Apply” Flow Chart (PDF – 100 KB)
- Annual Revenues from Patient Care Worksheet (XSLX – 26 KB)
- Annual Revenues Adjustment Worksheet (XSLX – 26 KB)
General Program Information
- Fact Sheet – General (PDF – 146 KB)
- Fact Sheet – Complex Organizational Structures (PDF – 184 KB)
- Frequently Asked Questions (FAQs)