Request for Filing Fee Waiver

BHBA’s Mandatory Fee Arbitration Program’s policy is to provide a waiver of all fees and costs, exclusive of arbitrator fees, to applicants who request a waiver and earn 300% or less of the federal poverty level.

Please view the chart for your household size and income here to verify your eligibility.

If you believe that you meet these requirements, please complete this form.

Complete this form in its entirety

Submission of this form will pause program deadlines to ensure no applicant is disadvantaged. The program chair will review all forms submitted. If you have any questions or need assistance, email .

Name(Required)
Mailing Address(Required)
Please enter a number greater than or equal to 0.
Clear Signature

Tells us who you need and when below