Financial Hardship Agreement: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Financial Hardship Agreement with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Financial Hardship Agreement in the editor.
Begin by entering your full name in the 'Patient Name' field. This identifies you as the individual requesting financial assistance.
Next, review the agreement carefully. Ensure you understand that by signing, you agree not to seek reimbursement from any third-party payor for services rendered under this arrangement.
Sign the document in the 'Patient Signature' field. This confirms your acceptance of the terms outlined in the agreement.
Enter the date you are signing in the 'Date Signed' field to document when this agreement takes effect.
If required, have a witness sign and date the form in their respective fields to validate your agreement.

Start using our platform today to easily complete your Financial Hardship Agreement online for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What is a financial hardship agreement?

A temporary financial hardship arrangement is between you and your credit provider for a specific period and either lets you stop making your repayments (which is known as deferring your repayments) or requires you to continue making repayments for a specific period but at a reduced amount.

What are examples of financial hardship?

Severe financial hardship is when you are unable to meet reasonable and immediate family living expenses like groceries, rent or medical costs. You may be able to access some of your super early to help.

What proof do you need for financial hardship?

Information that is relevant would include: Details of your income. Details of your expenses. The cause of your financial hardship (and evidence of the cause if available, for example, a medical certificate)

What qualifies as financial hardship?

Financial hardship may be deemed to exist when the debtor needs substantially all of his or her current and anticipated income and liquid assets to meet current and anticipated ordinary and necessary living expenses during the projected period of collection.

What is a qualifying financial hardship?

The Internal Revenue Service (IRS) allows for hardship withdrawals when there is an immediate and heavy financial need that cannot be fulfilled by any other reasonably available assets.