Common ACCESS Florida Forms
For a complete listing of DCF forms visit: http://www.dcf.state.fl.us/DCFForms/Search.aspx
General Program Forms
- ACCESS Florida Application (including Rights and Responsibilities and Personal Health Information Policy (HIPAA)) (Español, Kreyòl, Italian, French, Portuguese, Chinese, Vietnamese, Russian, Serbian)
- Change Report Form
- Verification of Dependent Care Expenses (Español) (Kreyòl)
- Verification of Employment/Loss of Income (Español) (Kreyòl)
- Verification of Shelter Expenses (Español) (Kreyòl)
- Financial Information Release (English and Español) (Kreyòl)
- Hearings Request for Public Assistance (Español) (Kreyòl)
- Child Support Cooperation Notice (Español) (Kreyòl)
- Child Support Cooperation Good Cause / Refusal to Cooperate (Español) (Kreyòl)
- Rights and Responsibilities (Español) (Kreyòl)
- Sample Fax Cover Sheet
Food Assistance Program Forms
- Authorized Representative Designation (Español)
- Food Stamp Work Registration Notice (Español) (Kreyòl)
- Verification of Dependent Care Expenses (Español) (Kreyòl)
Temporary Cash Assistance Program Forms
- Drug Testing Information Acknowledgement and Consent Release Form (Español) (Kreyòl)
- School Verification (Español) (Kreyòl)
- Change Report Form
- Immunization Verification for Public Assistance Applicant
- Notice of Learnfare Requirements (Español)
- Work Activity Referral (Español) (Kreyòl)
Medicaid Program Forms
- Appointment of a Designated Representative (Español) (Kreyòl)
- Informed Consent Long Term Care Assessment (Español) (Kreyòl)
- Medical Certification for Nursing Facility (Page 2)
- Patient Transfer and Continuity of Care (Page 2)
- Designation of Resources for Burial Funds
- Designation of Beneficiary
- Verification of Dependent Care Expenses (Español) (Kreyòl)
- Assignment of Rights to Support for Institutional Care Program
- Life Insurance Verification Request
- Authorization to Disclose Information (Español) (Kreyòl)
ACCESS Florida Brochures and Department Publications
- Community ACCESS Network Brochure
- ACCESS Florida On-Line Web Application Tip Card
- Medically Needy Brochure (Español) (Kreyòl)
- SUNCAP (Español) (Kreyòl)
- TANF State Plan
- TANF Work Verification Plan
- Justice For All Poster
- ICP Brochure
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