| Reference No. |
Reference Name |
Link |
Description |
| Ref-00981 |
ACCESS Florida Application CF-ES 2337 112011 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-00981 |
|
| Ref-00982 |
ACCESS Florida Web Application CF-ES 2353 092011 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-00982 |
|
| Ref-01204 |
Your Rights and Responsibilities CF-ES 2064 032012 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-01204 |
|
| Ref-01205 |
Notice of Case Action CF-ES 2235 022012 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-01205 |
|
| Ref-01349 |
Hardship Extension Review CF-ES 2082 062012 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-01349 |
|
| Ref-01530 |
Notice of Excess Home Equity Interest CF-ES 2354 05/2012 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-01530 |
|
| Ref-03155 |
Appointment of a Designated Representative CF-ES 2505 07/2013 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-03155 |
|
| Ref-03212 |
Medicaid Transfer Disposition Notice CF-ES 2358 072013 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-03212 |
|
| Ref-04808 |
DCF Form CF-ES 2095 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04808 |
Food Assistance Work Registration Notice, 7/2014
|
| Ref-04809 |
DCF Form CF-ES3052A |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04809 |
Change Report for Public Assistance Case
|
| Ref-04810 |
DCF Form CF-ES 2641 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-04810 |
Claim Notice Good Cause for Refusal to Cooperate
|
| Ref-05058 |
CF-ES 2635 07/2014 Protective Payee Agreement |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05058 |
65A-4.220 This form is incorporated in this Administrative Rule. It is the CF-ES 2635 07/2...
|
| Ref-05434 |
CF-ES 3415 Report of Suspected or Known Public Assistance Fraud |
http://www.flrules.org/Gateway/reference.asp?No=Ref-05434 |
Form to be used to report suspected or known public assistance fraud for the Public Assist...
|
| Ref-06801 |
Change Report Form CF-ES 3052A |
http://www.flrules.org/Gateway/reference.asp?No=Ref-06801 |
Change Report Form
|
| Ref-07159 |
65A-1.204 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-07159 |
|
| Ref-08119 |
CF-ES 2095 |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08119 |
Food Assistance Work Registration Notice Form CF-ES 2095
|
| Ref-08254 |
Overpayments |
http://www.flrules.org/Gateway/reference.asp?No=Ref-08254 |
65A-1.900
|
| Ref-09355 |
2341 Management Review Notice |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09355 |
|
| Ref-09356 |
2372 Trafficking Waiver |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09356 |
|
| Ref-09357 |
3056 Notification of Intent to Disqualify |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09357 |
|
| Ref-09358 |
3410 Wiaver of Administrative Disqualification Hearing with Program Loss |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09358 |
|
| Ref-09359 |
3410A Waiver of Disqualification Hearing without Program Loss |
http://www.flrules.org/Gateway/reference.asp?No=Ref-09359 |
|
| Ref-10089 |
3056_ Notification of Intent to Disqualify |
http://www.flrules.org/Gateway/reference.asp?No=Ref-10089 |
|
| Ref-11422 |
CF-ES 2264, Notice of Determination of Assets (or Income) Transfer |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11422 |
|
| Ref-11423 |
CF-ES 2264S, Notice of Determination of Assets (or Income) Transfer (in Spanish) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11423 |
|
| Ref-11424 |
CF-ES 2264H, Notice of Determination of Assets (or Income) Transfer (in Creole) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11424 |
|
| Ref-11428 |
CF-ES 2504, Assignment of Rights to Support |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11428 |
|
| Ref-11429 |
CF-ES 2504S, Assignment of Rights to Support (in Spanish) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11429 |
|
| Ref-11430 |
CF-ES 2504H, Assignment of Rights to Support (in Creole) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11430 |
|
| Ref-11431 |
CF-ES 2354, Notice of Excess Home Equity Interest |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11431 |
|
| Ref-11432 |
CF-ES 2354S, Notice of Excess Home Equity Interest (in Spanish) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11432 |
|
| Ref-11433 |
CF-ES 2354H, Notice of Excess Home Equity Interest (in Creole) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11433 |
|
| Ref-11455 |
CF-ES 2358 MEDICAID TRANSFER DISPOSITION NOTICE |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11455 |
|
| Ref-11456 |
CF-ES 2358h MEDICAID TRANSFER DISPOSITION NOTICE (in Creole) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11456 |
|
| Ref-11457 |
CF-ES 2358s MEDICAID TRANSFER DISPOSITION NOTICE (in Spanish) |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11457 |
|
| Ref-11578 |
CF-ES 2097 Communication and Work Activity Referral |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11578 |
|
| Ref-11579 |
CF-ES 2097H (Creole) Communication and Work Activity Referra |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11579 |
|
| Ref-11580 |
CF-ES 2097S (Spanish) Communication and Work Activity Referral |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11580 |
|
| Ref-11581 |
CF-ES 4192 Notice of Work Penalty |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11581 |
|
| Ref-11582 |
CF-ES 4192H (Creole) Notice of Work Penalty |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11582 |
|
| Ref-11583 |
CF-ES 4192S (Spanish) Notice of Work Penalty |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11583 |
|
| Ref-11627 |
CF-ES 2353 ACCESS Florida Web Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11627 |
|
| Ref-11634 |
CF-ES 2039 Medical Assistance Referral |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11634 |
|
| Ref-11635 |
CF-ES 2293 Child in Care Medicaid Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11635 |
|
| Ref-11636 |
CF-ES 2930 Screening for Expedited Medicaid Appts |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11636 |
|
| Ref-11637 |
CF-ES 2930H (Creole) Screening for Expedited Medicaid Appointments |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11637 |
|
| Ref-11638 |
CF-ES 2930S (Spanish) Screening for Expedited Medicaid Appointments |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11638 |
|
| Ref-11642 |
CF-ES 2620 Verification of Employment -Loss of Income |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11642 |
|
| Ref-11643 |
CF-ES 2620H (Creole) Verification of Employment_Loss of Income |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11643 |
|
| Ref-11644 |
CF-ES 2620S (Spanish) Verification of Employment_Loss of Income |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11644 |
|
| Ref-11645 |
CF-ES 2621 Verification of Dependent Care Expenses |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11645 |
|
| Ref-11646 |
CF-ES 2621H (Creole) Verification of Dependent Care Expenses |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11646 |
|
| Ref-11647 |
CF-ES 2621S (Spanish) Verification of Dependent Care Expenses |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11647 |
|
| Ref-11648 |
CF-ES 2622 Verification of Shelter |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11648 |
|
| Ref-11649 |
CF-ES 2622H (Creole) Verification of Shelter Expenses |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11649 |
|
| Ref-11650 |
CF-ES 2622S (Spanish) Verification of Shelter Expenses |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11650 |
|
| Ref-11651 |
CF-ES 2623 School Verification |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11651 |
|
| Ref-11652 |
CF-ES 2623H (Creole) School Verification |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11652 |
|
| Ref-11653 |
CF-ES 2623S (Spanish) School Verification |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11653 |
|
| Ref-11654 |
CF-ES 3007 Work Calendar |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11654 |
|
| Ref-11655 |
CF-ES 3007H (Creole) Work Calendar |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11655 |
|
| Ref-11656 |
CF-ES 3007S (Spanish) Work Calendar |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11656 |
|
| Ref-11657 |
CF-ES 990 Designation of Beneficiary |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11657 |
|
| Ref-11658 |
CF-ES 2514 Authorization to Disclose Information |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11658 |
|
| Ref-11660 |
CF-ES 2514H (Creole) Authorization to Disclose Information |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11660 |
|
| Ref-11661 |
CF-ES 2514S (Spanish) Authorization to Disclose Information |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11661 |
|
| Ref-11663 |
CF-ES 2613H (Creole) Financial Information Release |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11663 |
|
| Ref-11664 |
Florida’s Medicaid State Plan, Approved Conversion Thresholds |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11664 |
|
| Ref-11698 |
CF-ES 2337 ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11698 |
|
| Ref-11700 |
CF-ES 2337F (French-Canadian) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11700 |
|
| Ref-11701 |
CF-ES 2337H (Creole) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11701 |
|
| Ref-11702 |
CF-ES 2337I (Italian) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11702 |
|
| Ref-11703 |
CF-ES 2337P (Portuguese) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11703 |
|
| Ref-11704 |
CF-ES 2337R (Russian) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11704 |
|
| Ref-11705 |
CF-ES 2337S (Spanish) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11705 |
|
| Ref-11723 |
CF PI 165-107H (Creole) Are You Disabled and Applying for Medicaid brochure |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11723 |
|
| Ref-11724 |
CF_PI 165_107S (Spanish) Are You Disabled and Applying for Medicaid brochure |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11724 |
|
| Ref-11725 |
CF_PI 165-107 Notification of Disability Information and Request Form |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11725 |
|
| Ref-11726 |
CF-ES 2337SC (Serbo-Croatian) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11726 |
|
| Ref-11727 |
CF-ES 2337V (Vietnamese) ACCESS Florida Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11727 |
|
| Ref-11729 |
CF-ES 2370 Family Related Medical Assistance Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11729 |
|
| Ref-11730 |
CF-ES 2370H (Creole) Family-Related Medical Assistance Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11730 |
|
| Ref-11731 |
CF-ES 2370S (Spanish) Family-Related Medical Assistance Application |
http://www.flrules.org/Gateway/reference.asp?No=Ref-11731 |
|
| Ref-13625 |
CF-ES 2202h Adult Family Care Home Referral Notice |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13625 |
|
| Ref-13626 |
CF-ES 2202s Adult Family Care Home Referral Notice |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13626 |
|
| Ref-13627 |
CF-ES 2235h Notice of Case Action |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13627 |
|
| Ref-13628 |
CF-ES 2235s Notice of Case Action |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13628 |
|
| Ref-13629 |
CF-ES 2505h Appointment of a Designated Representative |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13629 |
|
| Ref-13630 |
CF-ES 2505s Appointment of a Designated Representative |
http://www.flrules.org/Gateway/reference.asp?No=Ref-13630 |
|
| Ref-16454 |
CF-ES 2082 Hardship Extension Review |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16454 |
|
| Ref-16455 |
CF-ES 2082H (Creole) Hardship Extension Review |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16455 |
|
| Ref-16456 |
CF-ES 2082S (Spanish) Hardship Extension Review |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16456 |
|
| Ref-16457 |
CF-ES 2094 Statement of the Need for Care |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16457 |
|
| Ref-16458 |
CF-ES 2094H (Creole) Statement of the Need for Care |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16458 |
|
| Ref-16459 |
CF-ES 2094S (Spanish) Statement of the Need for Care |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16459 |
|
| Ref-16460 |
CF-ES 2305 Relative Caregiver Program Request for Eligibility Consideration |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16460 |
|
| Ref-16461 |
CF-ES 2305H (Creole) Relative Caregiver Program Request for Eligibility Consideration |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16461 |
|
| Ref-16462 |
CF-ES 2305S (Spanish) Relative Caregiver Program Request for Eligibility Consideration |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16462 |
|
| Ref-16463 |
CF-ES 2635H (Creole) Protective Payee Agreement |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16463 |
|
| Ref-16464 |
CF-ES 2635S (Spanish) Protective Payee Agreement |
http://www.flrules.org/Gateway/reference.asp?No=Ref-16464 |
|