Florida Form Cf 831 PDF Details

In Florida, the process for Batterer Intervention Programs (BIPs) to achieve and maintain certification is delineated through the Florida CF 831 form, a comprehensive document that outlines the procedural and documentation requirements for new applications, renewals, and updates to ownership, address, or director information. This form serves as a critical conduit between the program operators and the Florida Department of Children & Families, ensuring that BIPs adhere to state laws and administrative codes. Entities seeking certification must navigate a variety of stipulations, including the submission of fees—$300 for new certifications and $150 for renewals—along with thorough program information, facilitator qualifications, legal ownership details, and the agreement to abide by all applicable rules and standards. Additionally, the form mandates the disclosure of schedule locations, onsite director, and facilitator information, emphasizing the importance of transparency and accountability in the operation of these intervention programs. The non-refundable fee underscores the commitment required in obtaining certification, which is valid for one year and non-transferable, highlighting the department's rigorous standards for compliance and the integrity of the BIPs’ operational frameworks.

QuestionAnswer
Form NameFlorida Form Cf 831
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesFEID, batterers intervention program florida online, omissions, 65H-2

Form Preview Example

 

Check Appropriate Box(es)

APPLICATION FOR CERTIFICATION

 

New - $300

 

 

Renewal - $150

 

BATTERER INTERVENTION PROGRAM

 

Change of Ownership

 

 

 

 

Change of Address

 

 

Change of Director

PLEASE TYPE OR PRINT LEGIBLY

Instructions: This application must be completed for new certification as well as annual renewal by the owner of the program or in the case of a corporation or partnership, the designated representative of the owner. A separate application and fee must be submitted for each circuit. Mail the application with the application fee and required documents to the department at the address provided. Make checks payable to the Department of Children & Families. Renewal of certification is contingent upon completion of any corrective action imposed by the department. An incomplete application will not be accepted.

PROGRAM INFORMATION

Program ID (Not required for new applications)

Name of Program as it is to appear on certification

Program Street Address (do not enter P.O. Box) If more than one location, attach additional sheet(s).

Judicial Circuit Served

City

County

Zip Code

Number of Locations within Circuit

Telephone No.

Fax No.

Email Address

Program Mailing Address, if different

City

County

Zip Code

GROUP(S) SCHEDULE

List locations, day, and time for group(s). For first-time applicants, list proposed schedule

STREET ADDRESS, CITY, COUNTY

DAY

TIME

 

 

 

 

 

 

 

 

 

 

 

 

ONSITE DIRECTOR INFORMATION (If multiple sites with multiple directors, attach additional sheets.)

For initial application, attach copy of resume and CF 1649D, Declaration of Good Moral Character form

Name of Director FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

City

County

Zip Code

Telephone No.

Fax No.

Email Address

FACILITATOR INFORMATION (Attach additional sheets if needed.)

All facilitators must be approved by the department. For each, attach college transcript, training certificates, current resume and CF 1649D, Declaration of Good Moral Conduc form. Attachments are not required for previously approved facilitators on renewal applications, but must be maintained in personnel file.

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

APPLICANT INFORMATION (Applicant is the person with authority to request certification.)

For initial application attach copy of resume and CF 1649D, Declaration of Good Moral Character form

Name of Applicant

FIRST

MIDDLE

LAST

Position/Title

 

 

 

 

 

Check One:

Owner

Designated Representative (Applicable to corporations and partnerships only.)

Applicant's Mailing Address

City

County

Zip Code

 

Telephone No.

 

Fax No.

 

Email Address

 

 

 

 

 

 

 

 

CF 831, January 2007

 

 

 

 

 

Authority: ss. 741.325-327, F.S.,

Chap. 65H-2, FAC

1 of 2

Office of Domestic Violence Program

LEGAL OWNERSHIP OF BIP

Complete only one of the categories listed below.

INDIVIDUAL

For initial application attach copies of resume, all licenses and CF 1649D, Declaration for Good Moral Conduct form

Name of Owner

FIRST

MIDDLE

LAST

Position/Title

 

 

 

 

 

FEID No.

Professional License No.

City Business License No.

Co. Business License No.

Business Mailing Address

City

County

Zip Code

Telephone No.

Fax No.

Email Address

Role in BIP (attach additional sheets if necessary):

CORPORATION (not-for-profit or for profit)

Attach certificate of status or acknowledgement letter of registration from the FL Dept. of State, and current list of directors with title, address and phone number. Failure by any corporation to comply with all requirements under Chapter 607, F.S., is grounds for rejection or suspension of certification.

Registered Name

FEID No.

Document No.

City Business License No.

County Business License No.

Registered Agent

Position/Title

Registered Mailing Address

City

County

Zip Code

Telephone No.

Fax No.

Email Address

Role in BIP (attach additional sheets if necessary):

PARTNERSHIP (limited or general)

Attach certificate of status or acknowledgement letter of registration from the FL Dept. of State, and a list of partners with title, address and phone number. Failure by any partnership to comply with all requirements under Chapter 620, F.S., is grounds for rejection or suspension of certification.

Registered Name

FEID No.

Document No.

City Business License No.

County Business License No.

Registered Agent

Position/Title

Registered Mailing Address

City

County

Zip Code

Telephone No.

Fax No.

Email Address

Role in BIP (attach additional sheets if necessary):

I declare that the named program in this application meets all standards for state certification as required by Chapter 65H-2, Florida Administrative Code and section 741.325, Florida Statutes. By submission of this application and upon approval by the Department of Children and Families, I agree to abide by all rules and statutes that apply to the operation of a certified batterer intervention program. I understand that any omissions, misstatements, or misrepresentations are grounds for rejection or suspension of certification. I understand that the certification fee is non-refundable and certification is for one year and non-transferable. I understand that knowingly making a false statement on this application constitutes a second- degree misdemeanor as provided in section 837.06, Florida Statutes. By signing this application, I am declaring that all the information given within this application is true and correct.

Signature of Applicant

 

Date

CF 831, January 2007

 

 

Authority: ss. 741.325-327, F.S., Chap. 65H-2, FAC

2 of

Office of Domestic Violence Program

ATTACHMENT 1

 

 

 

 

 

APPLICATION FOR CERTIFICATION

 

 

 

 

 

BATTERER INTERVENTION PROGRAM

 

 

 

 

 

ADDITIONAL PROGRAM LOCATIONS

Authority: ss. 741.325, 741.327, F.S., Chap. 65C-5, F.A.C.

 

 

 

 

 

 

 

PLEASE TYPE OR PRINT LEGIBLY

 

 

Instructions: For programs with more than one business location, please provide information for each location.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROGRAM & ONSITE DIRECTOR INFORMATION

 

 

A copy of the resume and DCF Form ___, Affidavit of Good Moral Character, is required for initial certification only.

Name of Program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Program Street Address (do not enter P.O. Box)

 

 

 

 

Number of Locations

 

 

 

 

 

 

 

 

 

 

City

 

 

 

County

 

 

Zip Code

 

Judicial Circuit

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

Fax No.

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

Name of Director

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

County

 

Zip Code

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

Fax No.

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Program Street Address (do not enter P.O. Box)

 

 

 

 

Number of Locations

 

 

 

 

 

 

 

 

 

 

City

 

 

 

County

 

 

Zip Code

 

Judicial Circuit

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

Fax No.

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

Program Mailing Address, if different

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

County

 

Zip Code

 

 

 

 

 

 

 

Name of Director

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

County

 

Zip Code

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

Fax No.

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Program Street Address (do not enter P.O. Box)

 

 

 

 

Number of Locations

 

 

 

 

 

 

 

 

 

 

City

 

 

 

County

 

 

Zip Code

 

Judicial Circuit

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

Fax No.

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

Program Mailing Address, if different

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

County

 

Zip Code

 

 

 

 

 

 

 

Name of Director

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

County

 

Zip Code

 

 

 

 

 

 

 

 

 

Telephone No.

 

 

Fax No.

 

 

Email Address

 

 

(

)

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CF 831, April 2006

Office of Domestic Violence Program

Page 1 of Attachment 1

ATTACHMENT 2

APPLICATION FOR CERTIFICATION

BATTERER INTERVENTION PROGRAM

FACILITATORS

Authority: ss. 741.325, 741.327, F.S., Chap. 65C-5, F.A.C.

PLEASE TYPE OR PRINT LEGIBLY

Instructions: Please list additional facilitators below.

FACILITATOR INFORMATION

All facilitators must be approved by the department. Attach copies of college transcripts, training certificates, current resume and DCF Form ___, Affidavit of Good Moral Conduct. Documents are not required for previously approved facilitators on renewal applications.

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

Name

FIRST

MIDDLE

LAST

Professional License No. (if applicable)

 

 

 

 

 

CF 831, April 2006

Office of Domestic Violence Program

Page 1 of Attachment 2

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