Economic Self Sufficiency Forms
For a complete listing of DCF forms visit: https://myflfamilies.com/forms
Application Forms
The quickest way to apply for Government Assistance is online through the MyACCESS portal. Individuals can also make changes, apply for additional assistance, check case status and more using the MyACCESS Portal. If you are unable to apply online and need a paper application, please use the forms below. Please note that only one application is needed, whether you apply online through the MyACCESS portal or use a paper application below.
- Family-Related Medicaid Application:
Print and fill out this application if you are pregnant or have children who are 20 or under living with you and only want to apply for Medicaid. - Government Assistance Application:
Print and fill out this application If you want to apply for Food Assistance and/or Temporary Cash Assistance, and to Medicaid.
General Program Forms
- Work Calendar (to report self-employment income)
- Change Report Form
- Verification of Dependent Care Expenses
- Verification of Employment/Loss of Income
- Verification of Shelter Expenses
- Financial Information Release
- Hearings Request for Public Assistance
- Child Support Cooperation Notice
- Child Support Cooperation Good Cause / Refusal to Cooperate
- Rights and Responsibilities
- Sample Fax Cover Sheet
Food Assistance Program Forms
Temporary Cash Assistance Program Forms
Medicaid Program Forms
- Appointment of a Designated Representative
- Informed Consent Long Term Care Assessment
- Designation of Resources for Burial Funds
- Designation of Beneficiary
- Assignment of Rights to Support for Institutional Care Program
- Life Insurance Verification Request
- Authorization to Disclose Information
Completed forms can be uploaded to your MyACCESS account. Completed forms and/or paper applications may also be mailed to the ACCESS Central Mail Center, P.O. Box 1770, Ocala, FL, 34478-1770, faxed to 1-866-886-4342, or hand-delivered to a Family Resource Center. Please note, the quickest way to apply for government assistance or submit forms is through the MyACCESS portal.