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One-Click Financial Hardship Form

If you are appealing and cannot afford to pre-pay the penalty, you may request a waiver while your appeal or extension request is being considered. To request a waiver, submit this form and supporting documents by clicking the button below.

Please read the instructions carefully

Important:

  1. Appeal or Extension Request Must Be Submitted with any Request for Financial Hardship. This Hardship form is not an Appeal Application form. You must submit your appeal by using the separate Appeal Application form that is found in this section of the OATH website at the same time you submit this form. If you only submit this Hardship form and do not submit an Appeal Application form, at the same time, you will not receive a response to your submission.
  2. Attach copies of financial documents that show an inability to pre-pay the penalty when emailing this form. For example, attach a copy of the first two pages of Respondent's federal tax return for last year or proof of receiving government assistance.
  3. If the Respondent's violation is not dismissed after the appeal is decided, the Respondent will still have to pay the penalty. This form cannot be used to ask OATH for a waiver of penalty if found in violation after the appeal, a reduction in the penalty amount, or a payment plan as OATH does not have the authority to grant such requests. Such requests will be automatically denied and you will not receive a response to your submission.

* Indicates required fields

Respondent name exactly as it appears on summons:


(If the respondent is an entity, business or corporation, please enter the full name exactly as it is written on the top of the summons using both boxes below. For example, First Name: ABC; Last Name: Corp.)

Name of person completing this form

Does Your Name Appear on the Summons?*

Mailing Address to Receive Determination

If no valid mailing address is provided, this e-form will be invalid and will not be considered by the Hearings Division.

Answer the Questions Below:

You must upload any supporting documentation which you may have (pictures, letters etc.)

Upload .jpeg, .pdf, .doc, files - Total file size cannot exceed 3Mb.

Upload .jpg, .pdf, or .doc file
Upload .jpg, .pdf, or .doc file
Upload .jpg, .pdf, or .doc file

If you have more than 3 documents to upload or the total size of the documents is more than 3 MB, then this One-Click request form may not be the right option for you. You may choose to make your request using the mail-in-form found on the forms section of this website.

If you are a Registered Representative, you must also attach the Registered Representative Authorization form. The Authorization form can be found on the forms section of this website.

Certification

Certification

By clicking the submit button below, I understand that I am signing and filing this application with the OATH Hearings Division. This has the same effect as signing by hand.


Please check "I'm not a robot" below to verify you are a person.

Attention users: you should only press the submit button one time. Once you click submit, you should receive a confirmation page. Print or save the confirmation page for your records.