Forms for Client Notice and Contact

RULE NO: RULE TITLE
65A-1.400: Forms for Client Notice and Contact
Notice is hereby given that the following changes have been made to the proposed rule published in Vol. 31, No. 20, May 20, 2005, issue of the Florida Administrative Weekly in accordance with subparagraph 120.54(3)(d)1., F.S. The specific changes were made in response to comments received from the Joint Administrative Procedures Committee and based on claims in Clark vs. Department of Children and Family Services. The changes are to clarify minimum information needed to initiate the application process and to correct form titles.

Specific changes in rule text are as follows:

The following forms are used for Public Assistance Programs to provide applicants and recipients with required notice of the agency’s and client’s rights and responsibilities and other necessary program information. The forms are hereby incorporated by reference.

(1) The application for assistance is a specific paper request on CF-ES Form 2337, ACCESS Florida Application, Aug 05, incorporated by reference, which has been dated and signed by the applicant or authorized/designated representative that eligibility for public assistance be determined. An application must include at least the individual’s name, address and signature to initiate the application process. Household members who are ineligible, or who are not applying for benefits, may be designated as non-applicants.

(2)(1) Forms that apply to two or more public assistance programs are:

(a) through (b) No change.

(c) CF-ES Form 2337,ACCESS Florida Application or Uniform
Aug 05Resource Locator (URL),www.myflorida.com/accessflorida

(d) through (p) No change.

(2) through (3) renumbered (3) through (4) No change.

(a) No change.

(b) CF-ES Form 1056, Feb 03Florida KidCare Program Notice of Case Action Application

(c) No change.

(d) CF-ES Form 2040, Feb 03Informed Consent Form

(d) through (m) renumbered (e) through (n) No change.

(n) CF-ES Form 2935, Jan 04Silver Saver (Application)

(5)(4) No change.

(a) No change.

(b) CF-ES Form 3400, Feb 06 03Florida Department of Children and Families Benefit Recovery
Request for Additional Information

(c) CF-ES Form 3410,Waiver of Administrative  Disqualification Hearing
Feb 06 Aug 01

(d) CF-ES Form 3410A,Waiver of Feb 06 03 Administrative Disqualification Hearing
With No Program Loss

(e) No change.

(6)(5) No change.

(a) CF-ES Form 2082, Sep 05 Feb 03Hardship Extension Exemption Review

(b) No change.

(c) CF-ES Form 2097, May 05 Aug 03Communication and Work Activity Referral

(d) CF-ES Form 2299, Feb 03Alcohol, Drug Abuse Substance Abuse and Mental Health
(ADM SAMH) Treatment Verification Form

(e) through (f) No change.

The edition date on some forms is listed with a notation that the edition replaces a previous edition that may still be used. This notation is to indicate that the new edition of the form does not implement a policy change and that supplies of the previous edition of a specific form may be exhausted prior to the use of the new edition.

(7)(2) Single copies of each form being incorporated by reference in this rule may be obtained without cost from the ESS office that serves your area or by written request to the Economic Self-Sufficiency Program Office, 1317 Winewood Boulevard, Building 3, Room 450, Tallahassee, Florida 32399-0700, or by using the department’s Internet site at on My Florida.com or its web-based application Uniform Resource Locator (URL) address, www.myflorida.com/ accessflorida.