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California PDF Forms

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Common Questions

What is the California FNP 004 form?

The California FNP 004 form is a notification form used for the renewal or hold release of a fictitious name permit. It is essential for medical practitioners operating under a fictitious name to ensure compliance with state regulations.

Who needs to fill out the FNP 004 form?

Any medical professional or entity currently doing business under a fictitious name in California must complete this form. This includes sole proprietors, partnerships, and corporations that wish to renew their fictitious name permit or address any changes in ownership.

What information is required on the form?

The form requires several key pieces of information:

  • Fictitious name
  • Current physical practice address (no P.O. Box)
  • FNP number
  • Social Security Number (SSN) or Federal Employer Identification Number (FEIN)
  • Contact phone number
  • Details about the ownership structure (individual, partnership, corporation)

What is the renewal fee for the FNP 004 form?

The renewal fee for the fictitious name permit is specified on the form. It is important to check the latest fee schedule as it may vary.

Can the fictitious name permit be transferred to another owner?

No, a fictitious name permit is not transferable. If a medical practice is sold, the former owner must cancel the permit, and the new owner must apply for a new fictitious name permit.

What should I do if I want to add or remove partners or shareholders?

If you are operating as a corporation or partnership and wish to add or remove partners or shareholders, you must provide the necessary information in the designated section of the form. Signatures are required for both association and disassociation.

What happens if there is a hold on my fictitious name permit?

If a hold has been placed on your fictitious name permit, you must complete the FNP 004 form in its entirety and have it signed by a current owner to remove the hold.

What is the significance of the declaration at the bottom of the form?

The declaration at the bottom of the form is a legal affirmation that the information provided is true and correct. By signing, the individual confirms they have the authority to act on behalf of the entity and acknowledges the penalties for false statements.

Where should I send the completed FNP 004 form?

The completed form should be mailed to the Medical Board of California at the address provided on the form. Ensure that all required attachments are included to avoid processing delays.

How can I contact the Medical Board of California for assistance?

You can reach the Medical Board of California by phone at (916) 263-2382 or by fax at (916) 263-2487. Additional information is also available on their website at www.mbc.ca.gov.

Document Specifications

Fact Name Details
Governing Law The FNP 004 form is governed by California Business and Professions Code Section 17900 et seq.
Purpose This form is used for the notification of renewal or hold release of a fictitious name permit for medical practices.
Fictitious Name The form requires the current fictitious name under which the medical practice operates.
Owner's Signature A current owner must sign the form to validate the information and authorize any changes.
Non-transferability A fictitious name permit cannot be transferred to another party without proper cancellation and application processes.
Renewal Fee The renewal fee for the fictitious name permit must be submitted along with the completed form.
Record Keeping It is essential to maintain accurate records, as the form must be completed in its entirety.
Attachments Refer to the enclosed attachment for information about current owners and any necessary signatures.

Dos and Don'ts

When filling out the California FNP 004 form, it is crucial to adhere to specific guidelines to ensure accuracy and compliance. Below is a list of actions to take and avoid:

  • Do complete all sections of the form thoroughly. Incomplete forms may lead to processing delays.
  • Do provide the current physical practice address. Do not use a P.O. Box.
  • Do ensure that the form is signed by a current owner to avoid any issues with the renewal process.
  • Do submit the form along with the renewal fee to the appropriate address.
  • Don't forget to check if a hold has been placed on your Fictitious Name Permit before submitting the form.
  • Don't assume that the fictitious name permit is transferable. Follow the proper procedures if ownership changes.

Misconceptions

Misconceptions about the California FNP 004 form can lead to confusion among medical professionals. Here are six common misunderstandings:

  • 1. The form can be submitted without a signature. Many believe that a signature is optional. However, the form requires a signature from a current owner to be valid.
  • 2. Fictitious name permits are transferable. Some assume that if a medical practice changes ownership, the fictitious name permit can simply be transferred. In reality, the former owner must cancel the permit, and the new owner must apply for a new one.
  • 3. A hold on the permit can be lifted without completing the form. There is a misconception that a hold can be removed informally. Completing the FNP 004 form in full is necessary to lift any holds on the permit.
  • 4. The form is only for corporations and partnerships. Some think that only corporations or partnerships need to fill out this form. In truth, sole proprietors also need to use it if they are doing business under a fictitious name.
  • 5. Address changes do not require a new application. Many believe that they can simply notify the board of an address change without using the form. However, any change of address must be reported on the FNP 004 form.
  • 6. The renewal fee is optional. Some individuals think that the renewal fee can be waived. This is not the case; the renewal fee must be paid to keep the fictitious name permit active.

Understanding these points can help ensure compliance with the regulations governing fictitious name permits in California.

Documents used along the form

The California FNP 004 form is essential for managing fictitious name permits in medical practices. However, several other forms and documents often accompany it. Understanding these documents can help ensure compliance and smooth operations for medical professionals in California.

  • Application for Cancellation of a Fictitious Name Permit: This form is used when a medical practice is sold or transferred. The previous owner must submit it to officially cancel the fictitious name permit.
  • Fictitious Name Permit Application: New owners of a medical practice must fill out this application to obtain a fictitious name permit. It ensures the name is officially registered under their ownership.
  • Change of Address Form: If a practice moves to a new location, this form must be submitted to update the address associated with the fictitious name permit.
  • Shareholder/Partner Change Form: This document is necessary when adding or removing shareholders or partners in a corporation or partnership. Signatures from involved parties are required.
  • Business License Application: Medical practices often need a local business license to operate legally. This application varies by city or county and must be obtained before opening.
  • Tax Identification Number (TIN) Application: This form is used to apply for a TIN from the IRS, which is necessary for tax purposes and to establish the business entity.
  • Professional Liability Insurance Certificate: Proof of insurance is often required for medical practices. This document shows that the practice has coverage in case of malpractice claims.
  • Employee Registration Forms: If hiring staff, these forms are necessary to register employees with the appropriate state and federal agencies for tax and labor purposes.

Each of these documents plays a critical role in the operation of a medical practice in California. Staying organized and ensuring all forms are completed accurately can help avoid complications down the line.