Form Cf Es 2337, also known as the U.S. Government Report on Employee Compensation and Benefits, is a comprehensive report that details the salaries and benefits of all federal employees. The report is compiled every two years by the Office of Personnel Management (OPM), and it covers employees from over 100 agencies across the government. In addition to salary information, the report also provides data on employee benefits, including retirement and health care programs. This year's report was released in June 2017, and it offers some interesting insights into government compensation trends.
This quick guide can help you find out how much time it'll require you to fill out form cf es 2337, the number of pages it's got, and a few additional unique specifics of the file.
Question | Answer |
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Form Name | Form Cf Es 2337 |
Form Length | 7 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 1 min 45 sec |
Other names | florida food stamp application pdf, florida cf es children families, fl cf access dcf, florida access application printable |
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Do you have a reason that makes it difficult for you to come to the office for an interview? |
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Date Stamp:______________________ |
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Illness |
Transportation |
Work or Training |
Live in a Rural Area |
Care for a |
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Application |
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sick or Disabled Household Member |
Other (explain): |
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Case Number: |
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I would like to apply for: |
Food Assistance |
Cash |
Relative Caregiver |
OSS/Optional State Supplementation |
Medical |
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Medicaid Waiver/Home & Community |
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Based Services |
Hospice |
Nursing Home Care – Living address prior to entering Nursing Home: |
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Welcome to the Florida Department of Children and Families (DCF). If you need help in completing this |
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EXPEDITED FOOD ASSISTANCE – Eligible households may receive food assistance benefits within 7 days |
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application or need interpreter services, please contact ACCESS Florida at |
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Is your household’s gross income less |
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YES |
NO |
Do you pay to heat or cool |
YES |
NO |
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your name, address, and a signature. Processing begins the day we receive your signed application. |
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than $150? |
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your home? |
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members who are ineligible, or who are not applying for benefits, may be designated as |
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Are your total liquid assets (such as cash, |
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YES |
NO |
What is the monthly amount |
$ |
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applicants, or persons applying only for Emergency Medicaid, Refugee Cash Assistance, or Refugee Medical |
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bank accounts, etc) less than $100? |
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of your rent or mortgage? |
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Assistance, are NOT required to provide a Social Security Number (SSN) based on the Food Stamp Act. If you are |
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Is your household’s monthly gross |
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Has all of your household’s |
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not eligible for an SSN because of your immigration status, you may be eligible for a |
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income plus your total liquid assets less |
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income recently stopped? |
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benefits that require one. If you need an SSN, we can help you apply for one. |
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YES |
NO |
YES |
NO |
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than your monthly rent or mortgage plus |
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If yes, WHEN? |
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provide proof of immigration status. Noncitizens who are applying for benefits will have their immigration status |
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utilities? |
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verified with the United States Citizenship and Immigration Services (USCIS). We will not tell USCIS about the |
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immigration status of those living in your household who are not applying for benefits. Under no circumstances will |
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Check the bills you pay: |
Electricity |
Gas |
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Is anyone in your household a |
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migrant or seasonal farmworker? |
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individuals who are not applying for benefits be reported as not lawfully residing in the United States. If you are |
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YES |
NO |
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completing this application for someone else, answer the questions based on their circumstances. |
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Water |
Sewage |
Phone |
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If yes, WHO? |
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APPLICANT INFORMATION
Name: |
First |
Middle |
Last |
Home or Message Phone Number:
Home Address: |
Street |
Apt. No. |
City |
State |
Zip Code |
Work Phone Number:
Address where you get your mail (if different from where you live): |
Street/P. O. Box |
City |
State |
Zip Code |
Cell Phone Number:
INFORMATION FOR ALL PROGRAMS |
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Is anyone in your home fleeing the |
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YES |
NO |
If yes, |
Has anyone in your home been |
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YES |
NO |
If yes, |
Has anyone in your home ever been convicted of |
YES |
NO |
If yes, |
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law due to a felony or a probation or |
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convicted of a drug trafficking |
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receiving food assistance, temporary cash assistance, |
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parole violation? |
who? |
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felony? |
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who? |
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or Medicaid in more than one state at the same time? |
who? |
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Has anyone in your home sold or |
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YES |
NO |
If yes, |
Did anyone in your home quit a job in |
YES |
NO |
If yes, |
Has anyone in your home received food, cash, or |
YES |
NO |
If yes, |
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the last 60 days or is anyone on |
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medical assistance from another state or source in |
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given away any property or assets in |
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the last 5 years? |
who? |
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strike? |
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who? |
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the last 30 days? |
who? |
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STATEMENT OF UNDERSTANDING |
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SIGNATURES |
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I understand that information that I provide with this application, interview, or when requesting other |
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benefits, including computer information matches with other agencies, is subject to verification by |
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_____________________________________________________ |
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DCF and other Federal and State agencies including Division of Public Assistance Fraud (DPAF). |
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Signature of Adult Household Member |
Date Signed |
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I understand and agree to the following: DCF, DPAF, and authorized Federal Agencies may verify |
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the information I give on this form, interview, or when requesting other benefits. Information may |
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_____________________________________________________ |
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be obtained from my past or present employers. My signature authorizes release of such |
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Signature of Witness if signed with an “X” |
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information to DCF and/or DPAF. As a condition of participation in Medicaid, I consent to review |
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and release of all medical records deemed necessary by Medicaid under its auditing and |
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Authorized/Designated Representative – Print Name, Address, and Phone |
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investigatory powers. If any information is incorrect, benefits may be reduced or denied and I may |
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____________________________________________________________ |
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be subject to criminal prosecution or disqualified from the program for knowingly providing incorrect |
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or false information or hiding information. I have read my Rights and Responsibilities. I certify |
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____________________________________________________________ |
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under penalty of perjury that the information on this form is true to the best of my knowledge, |
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including the citizen or noncitizen status of those who are applying for benefits. I hereby |
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acknowledge receipt of the Florida DCF CFOP |
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____________________________________ |
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and Protection of Personal Health Information Policy. |
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Signature of Authorized/Designated Representative |
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Application continues on page 2. Please provide as much information as you can to help us determine your eligibility quickly. |
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FOR OFFICE USE ONLY |
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Community Access Site Participant Name/Phone Number: |
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Date Stamp: |
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1 |
HOUSEHOLD INFORMATION: If you need extra space in the following sections, please use extra pages. Please provide as much information as you can to help us determine your eligibility quickly.
List yourself and all those living in your home even if you are not applying for them. If you are not applying for a member, you do not have to give their SSN or citizenship status. |
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If living in a nursing home or other institutional arrangement, list only self, spouse and dependents. |
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OPTIONAL INFORMATION – ETHNICITY: A = Hispanic or Latino; B = Not Hispanic or Latino |
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RACE: You may choose one or more numbers: |
1 – American Indian or Alaskan Native, 2 – Asian, |
3 – Black or African American, |
4 – Native Hawaiian, |
5 – White |
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Section A – List All Adults Living At Your Address |
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Legal Name |
Relationship |
Want to |
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Social Security |
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Date and Place |
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Ethnicity |
Race |
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Marital |
Attends School/ |
Buys and |
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Sex |
Number (see |
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U.S. Citizen |
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(see |
(see |
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# Hours/Week/ |
Eats Food |
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First, Middle, Last |
to you |
Apply? |
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of Birth |
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Status |
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instructions above) |
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above) |
above) |
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Last Grade Completed |
with You |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
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# hours |
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YES |
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SELF |
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3 |
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per week:____________ |
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NO |
M |
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B |
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NO |
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4 |
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Last Grade |
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5 |
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Completed:___________ |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
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# hours |
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YES |
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3 |
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per week:____________ |
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NO |
M |
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B |
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NO |
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4 |
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Last Grade |
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5 |
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Completed:___________ |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
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# hours |
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YES |
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3 |
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per week:____________ |
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NO |
M |
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B |
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NO |
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4 |
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Last Grade |
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5 |
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Completed:___________ |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
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# hours |
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YES |
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3 |
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per week:____________ |
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NO |
M |
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B |
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NO |
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4 |
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Last Grade |
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5 |
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Completed:___________ |
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Section B – List All Children Living At Your Address. If anyone is pregnant, list “unborn” as the name and the due date as the date of birth.
Legal Name |
Relationship |
Want to |
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Social Security |
Date and Place |
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Ethnicity |
Race |
Child under |
Attends School/ |
Date To |
Buys and |
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Sex |
Number (see |
U.S. Citizen |
(see |
(see |
Eats Food |
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First, Middle, Last |
to you |
Apply? |
of Birth |
Age 5 |
School Name |
Graduate |
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instructions above) |
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page 2) |
page 2) |
Immunized |
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with You |
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Child 1 |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
YES |
If yes, school name: |
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YES |
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3 |
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Would you like this child to get |
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M |
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B |
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NO |
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4 |
NO |
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NO |
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child health checkup services? |
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YES |
NO |
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5 |
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Child 2 |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
YES |
If yes, school name: |
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YES |
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3 |
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Would you like this child to get |
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M |
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B |
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NO |
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4 |
NO |
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NO |
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child health checkup services? |
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YES |
NO |
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5 |
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2 |
Section B – List All Children Living At Your Address. If anyone is pregnant, list “unborn” as the name and the due date as the date of birth.
Child 3 |
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YES |
NO |
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1 |
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YES |
NO |
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2 |
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YES |
F |
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USCIS # |
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A |
YES |
If yes, school name: |
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3 |
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Would you like this child to get |
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M |
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B |
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NO |
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4 |
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child health checkup services? |
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If yes, school name: |
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Would you like this child to get |
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child health checkup services? |
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YES
NO
YES
NO
Medicaid: For children under age 16, if no other proof of identity is available such as school records or photo ID, read and sign below: I certify under penalty of perjury that all the children listed above are who I claim them to be.
__________________________________________
Signature
Section C – Absent Parent Information: Provide the following information for each child in Section B whose mother and/or father is not in the home. |
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Absent Parent’s Name and Last Known Address |
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(see pg.2) |
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Mother |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Mother’s Place of Birth |
Mother’s Phone Number |
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Medical Insurance Information |
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parent? |
YES |
NO |
if not approved for benefits? |
YES |
NO |
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Carrier |
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Policy |
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Name: |
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Child 1 |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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Absent Parent’s Name and Last Known Address |
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Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Father |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Father’s Place of Birth |
Father’s Phone Number |
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Medical Insurance Information |
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parent? |
YES |
NO |
if not approved for benefits? |
YES |
NO |
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Carrier |
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Policy |
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Name: |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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Absent Parent’s Name and Last Known Address |
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Date of Birth |
Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Mother |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Mother’s Place of Birth |
Mother’s Phone Number |
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Medical Insurance Information |
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parent? |
YES |
NO |
if not approved for benefits? |
YES |
NO |
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Carrier |
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Policy |
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Name: |
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Child 2 |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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Absent Parent’s Name and Last Known Address |
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Date of Birth |
Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Father |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Father’s Place of Birth |
Father’s Phone Number |
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Medical Insurance Information |
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parent? |
YES |
NO |
if not approved for benefits? |
YES |
NO |
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Carrier |
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Policy |
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Name: |
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Number: |
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Father’s |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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3 |
Section C – Absent Parent Information: Provide the following information for each child in Section B whose mother and/or father is not in the home.
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Absent Parent’s Name and Last Known Address |
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Date of Birth |
Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Mother |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Mother’s Place of Birth |
Mother’s Phone Number |
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Medical Insurance Information |
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parent? |
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YES |
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NO |
if not approved for benefits? |
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YES |
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NO |
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Carrier |
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Policy |
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Name: |
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Child 3 |
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Mother’s |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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Absent Parent’s Name and Last Known Address |
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Date of Birth |
Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Father |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Father’s Place of Birth |
Father’s Phone Number |
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Medical Insurance Information |
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parent? |
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YES |
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NO |
if not approved for benefits? |
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YES |
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NO |
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Carrier |
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Policy |
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Name: |
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Father’s |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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Absent Parent’s Name and Last Known Address |
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Date of Birth |
Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Mother |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Mother’s Place of Birth |
Mother’s Phone Number |
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Medical Insurance Information |
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parent? |
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YES |
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NO |
if not approved for benefits? |
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YES |
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NO |
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Carrier |
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Policy |
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Name: |
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Number: |
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Child 4 |
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Mother’s |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
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Absent Parent’s Name and Last Known Address |
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Date of Birth |
Social Security No. |
Race |
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Reason for Absence |
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(see pg.2) |
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Father |
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Is this the child’s legal |
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Do you want Child Support Enforcement services |
Father’s Place of Birth |
Father’s Phone Number |
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Medical Insurance Information |
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parent? |
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YES |
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NO |
if not approved for benefits? |
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YES |
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NO |
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Carrier |
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Policy |
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Name: |
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Number: |
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Father’s |
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Employer’s |
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Employer’s |
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Employer’s Name: |
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Address: |
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Phone #: |
Section D – General Information: Answer the following questions about those listed in Sections A and B who are applying for assistance.
1. |
Is everyone a resident of the state of Florida? |
YES |
NO |
If no, who is not? |
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2. |
Is anyone in the household pregnant? |
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YES |
NO |
Who? |
Due Date: |
# Babies Due: |
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* 3. |
Has anyone attended a school conference for any of the children who are ages |
YES |
NO |
Who? |
When? |
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4. |
Has anyone or their parent (if still a child) or deceased spouse (if applicable) served in the U.S. military? |
YES |
NO |
Who? |
When? |
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5. |
Is anyone in your household a sponsored noncitizen? |
YES |
NO |
Who? |
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6. |
Is anyone living in a special setting such as a homeless shelter, drug treatment center, nursing home, |
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Who? |
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assisted living facility, adult family care home, mental health residential treatment facility, or other |
YES |
NO |
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||
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||||
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institution? |
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Facility Name and Type: |
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7. |
Is anyone a foster child? |
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YES |
NO |
Who? |
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* 8. |
Are any of the children limited or prevented in any way in his or her ability to do the things most |
YES |
NO |
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children of the same age can do? |
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Who? |
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||
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* 9. |
Do any of the children need to get special therapy, such as physical, occupational or speech |
YES |
NO |
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therapy, or treatment or counseling for an emotional, developmental, or behavioral problem? |
Who? |
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*10. Do any of the children need or use more medical care, mental health, or educational services |
YES |
NO |
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than is usual for most children of the same age? |
Who? |
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11. |
If you are applying for nursing home type services, do you have a child (of any age) living in your home |
YES |
NO |
Who? |
What is their relationship to you? |
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who is blind or disabled? |
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12. |
Has anyone been determined disabled by Social Security or the State of Florida? |
YES |
NO |
Who? |
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* Indicates information is optional for the Food Assistance Program |
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|
4 |
Section D – General Information: Answer the following questions about those listed in Sections A and B who are applying for assistance.
13. |
Is anyone claiming to be disabled who has not already been determined disabled by Social Security or |
YES |
NO |
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|
the State of Florida? |
Who? |
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||
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||
14. |
Has anyone been denied Supplemental Security Income (SSI) in the past 90 days? |
YES |
NO |
Who? |
When? |
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||
*15. Does anyone in your household need help with Medicare premiums or medical bills from the past |
YES |
NO |
Who? |
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|
three (3) months? |
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|||
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|
*16. Does anyone who was denied for disability have a new medical condition not considered by the |
YES |
NO |
Who? |
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|
Social Security Administration? |
|
|||
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|
17. |
Is anyone in your household a victim of human trafficking? (Victims of human trafficking are people |
YES |
NO |
Who? |
|
|
taken, kept, or moved by force or fraud for sexual exploitation or forced labor.) |
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|||
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If you need extra space in the following sections, please use extra pages.
Section E – Assets & Insurance: Answer the following questions about those listed in Sections A and B who are applying for assistance.
1.Does anyone that you are applying for own all or part of any assets, such as: vehicles, bank accounts, tax sheltered accounts, property, Certificates of Deposit (CDs), cash, mortgage notes, promissory notes, *loans, *IRAs, *401Ks, bonds, annuities, stocks, real estate, life estate, trusts, *Keogh plans, *continuing care retirement community or life care community contracts, burial contracts/plots, prepaid funeral expenses, savings bonds or certificates, business assets, large sums of money received in last 3 months,
child applicants if living in the home and assets/insurance of spouses of applicants if living in the home. |
YES |
NO If yes, list below: |
IMPORTANT INFORMATION FOR OWNERS OF AN ANNUITY: In accordance with Public Law
Individual |
Type of Asset or Insurance |
Vehicles |
Amount Owed on |
Location of Asset/Insurance |
Account # or |
Amount |
|
Year, Make, Model |
Vehicle/Property |
Bank/Company Name and Address |
Insurance ID # |
or Value |
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2. |
Are any of the above assets set aside to cover burial expenses? |
YES |
NO Which? |
What Amount? |
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|
3. |
Has anyone closed bank accounts or other investments, added anyone to the |
|
|
Who? |
When? |
|
title of an asset, given away assets or property, or liquidated assets greater |
YES |
NO |
||
|
What? |
Value? |
|||
|
than $3,000 to buy another asset or service in the last 5 years? |
|
|
||
|
|
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|
|
Section F – Income: Answer the following questions about those listed in Sections A and B who are applying for assistance.
1. Does anyone that you are applying for receive any type of income, such as: wages, tips,
payments, training allowances, etc? (Include the income of parents living at home with minor child applicants and income of spouses and dependents of applicants if living in the home.) |
YES |
NO |
If yes, list |
below: |
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Individual
Type of Income
Name of Employer or
Source of Income
Phone Number
of Employer
Monthly Amount |
How Often Received |
Before Deductions |
(weekly/biweekly/monthly) |
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Pay Day on What Day of the Week
Weekly # of Work Hours
2.Has anyone’s income in the household ended in the last 60 days?
YES
NO
Who?
When?
Source?
* Indicates information is optional for the Food Assistance Program |
5 |
Section F – Income: Answer the following questions about those listed in Sections A and B who are applying for assistance.
3. |
Will anyone in your household receive additional |
YES |
NO |
Who? |
Gross amount (before deductions) received in this month only? |
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income from the source that ended? |
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When? |
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4. |
Does anyone have a pending application for Social |
YES |
NO |
Who? |
Which Benefit? |
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Security or Unemployment Compensation benefits? |
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5. |
Have deposits been made to Income or Miller Type |
YES |
NO |
Whose Trust? |
Date(s) and Amount(s) of Deposit(s): |
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Trusts in any of the past 3 months? |
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Section G – Expenses: Answer the following questions about those listed in Sections A and B who are applying for assistance.
1.Is anyone that you are applying for required to pay expenses, such as: rent, mortgage, property tax, homeowner’s insurance, condo/maintenance fees, gas, electric, fuel, LIHEAP, medical bills such as but not limited to: prescriptions, glasses, transportation, doctor visits, dental, health aides, hospitalization, or insurance or Medicare premiums not covered by insurance or another third party, telephone, day (child) care, or court ordered child
support for a child not in your household? Include the expenses of parents of minor child applicants if living in the home and expenses of spouse of applicants if the spouse is living at home. |
YES |
NO If yes, |
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list below: |
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Type of Expense |
Who is Obligated to |
If a Medical Expense, Who |
Monthly |
Paid to Whom |
Date Paid |
Still Owed? |
For Court Ordered Child Support Only, |
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Pay This Expense |
Received the Medical Service? |
Amount |
Name of Child for Whom Support is Paid |
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NO |
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YES |
NO |
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2. How do you heat or cool your home?
3. Does anyone help you pay expenses? |
YES |
NO If yes, explain: |
YOU CAN APPLY TO REGISTER TO VOTE HERE
If you are not registered to vote where you live now, would you like to register to vote here today? Check YES if you would like to apply to register to vote or update your voter registration information. If you check the NO box or do not check a box, you will be considered to have decided not to apply to register to vote or update your voter registration information. Checking
YES, NO, or leaving this question blank will not affect your receipt of benefits. |
YES |
NO |
NOTICE OF RIGHTS
Help: If you would like help in filling out your voter registration application, we will help you. The decision whether to seek or accept help is yours. You may fill out the voter registration application in private.
Benefits: If you are applying for public assistance from this agency, applying to register, or declining to register to vote will not affect the amount of assistance you will be provided by this agency.
Privacy: Your decision not to register or update your record and the location where you applied to register or update your voter registration record is confidential and may only be used for voter registration purposes.
Formal Complaint: If you believe someone has interfered with either your right to apply to register or to decline to register to vote, your right to privacy in deciding whether to apply to
register to vote, or your right to choose your own political party or other political preference, you may file a complaint with: Florida Secretary of State, Division of Elections, NVRA Administrator, R.A. Gray Building, 500 S. Bronough Street, Tallahassee, Florida
[Authority: National Voter Registration Act (42 U.S.C. 1973 gg); ss. 97.023, 97.058 and 97.0585, F.S.]
YOU MAY BE ELIGIBLE FOR REDUCED TELEPHONE RATES |
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Check YES if you would like DCF to release your Name, SSN, Phone Number, and the fact that you receive food assistance, Temporary Cash Assistance, or Medicaid to the local |
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telephone company so you may receive a reduced telephone rate through the Lifeline Program. |
YES |
NO |
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6 |
NOTICE OF PENALTIES
You may be subject to prosecution for knowingly providing incorrect information to receive public assistance benefits.
REPORTING REQUIREMENTS
You must report any change in your situation according to program requirements to DCF. Food assistance households are required to report changes that increase benefits and food assistance households with a member disqualified for breaking program rules, felony drug trafficking, running away from a felony warrant, or not participating in a work program must report when the household’s monthly income exceeds the food assistance gross income limit for the household size. Households receiving Medicaid or Temporary Cash Assistance must continue to report changes that could affect eligibility within 10 days.
IMPORTANT INFORMATION FOR IMMIGRANTS
Applying for or receiving food assistance benefits or Medicaid will not affect you or your family members’ immigration status or ability to get permanent resident status (green card). Receiving Temporary Cash Assistance or
NOTICE OF PENALTIES – Food Assistance:
If you are found guilty (by a state or federal court, or an administrative disqualification hearing, or sign a hearing waiver) of intentionally making a false or misleading statement, concealing or withholding facts in order to receive or in an attempt to receive food assistance or committing any act that violates the Food and Nutrition Act, food assistance regulations, or any state statute for purposes of using, presenting, transferring, acquiring, receiving, or possessing food assistance benefits, you will be disqualified. You will be ineligible for food assistance for 12 months for the first violation, 24 months for the second violation and permanently for the third violation. If you are convicted of trafficking in food assistance benefits of $500 or more, you will be disqualified permanently. If you are convicted of these acts, depending on the severity, you may be fined up to $250,000, imprisoned for up to 20 years, or both.
If you are convicted by a state or federal court of making a fraudulent statement with respect to identity or residency in order to receive food assistance in more than one state at the same time, you will be ineligible to participate in the Food Assistance Program for a period of 10 years.
If you are fleeing to avoid prosecution, custody, or confinement, after conviction for a crime or an attempt to commit a crime, which is a felony, or are in violation of probation or parole imposed under a federal or state law, you are ineligible for food assistance. This information may be disclosed to other federal and state agencies for official examination, and to law enforcement officials for the purpose of apprehending persons fleeing to avoid the law.
If you are found guilty of a
NOTICE OF PENALTIES – Temporary Cash Assistance:
If you intentionally give false information or hide information to receive or continue to receive Temporary Cash Assistance and are convicted by a state or federal court or by an administrative disqualification hearing, or sign a hearing waiver, you may be disqualified for 12 months for the first violation, 24 months for the second violation and permanently for the third violation.
If you are found guilty of a
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
No person shall, on the basis of race, color, religion, national origin, sex, age, or disability be excluded from participation in, be denied the benefits of, or be subjected to unlawful discrimination under any program or activity receiving or benefiting from federal financial assistance and administered by the Department. To file a complaint, alleging violations of this policy, contact the Office of Civil Rights, Florida Department of Children and Families, 1317 Winewood Boulevard, Tallahassee, Florida
TDD
In accordance with Federal Law and U. S. Department of Agriculture (USDA) and U. S. Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited also on the basis of religion or political beliefs. To file a complaint of discrimination, contact USDA or HHS. Write USDA, Director, Office of Adjudication, 1400 Independence Avenue, S. W., Washington, D. C. 20250- 9410 or call toll free (866)
SUBMITTING THE APPLICATION FOR ASSISTANCE
An Application for Assistance may be submitted to any Department of Children and Families Economic
7 |