Free Florida Kidcare Form

What is the purpose of the Florida KidCare Employment Statement?

The Florida KidCare Employment Statement is a form designed to gather necessary employment information for family members applying for KidCare health insurance. This information assists in determining eligibility based on income. Each employer providing income to a family member must complete this form, unless recent pay stubs are submitted instead.

How should I complete the form?

The form consists of two sections. Section A must be filled out by the employee, including their family account number, signature, name, and Social Security number. After completing Section A, the employee should submit the form to their employer for Section B to be completed. Section B requires the employer to provide details about the employee's work hours, pay frequency, gross pay rate, and any variations in pay. Once completed, the form should be sent to Florida KidCare at the specified address.

What information is required from the employer?

Employers are required to provide several pieces of information in Section B. This includes the number of hours worked per week, the frequency of pay (daily, weekly, bi-weekly, etc.), the rate of gross pay, and any explanations for variations in hours or pay. Additionally, the employer must sign the form, affirming that the information provided is accurate to the best of their knowledge.

What should I do if my employer refuses to complete the form?

If an employer refuses to complete the Florida KidCare Employment Statement, the employee can still submit recent pay stubs as an alternative. These pay stubs should clearly indicate the employee's income and employment status. If neither option is available, the employee may need to contact Florida KidCare for guidance on how to proceed with the application.

Where do I send the completed form?

Once the Florida KidCare Employment Statement is completed by both the employee and employer, it should be mailed to Florida KidCare at the following address: P.O. Box 591, Tallahassee, Florida, 32302-0591. Ensure that the form is signed and all necessary information is filled out to avoid delays in the application process.

Incomplete Information: One common mistake is failing to fill out all required fields. Ensure that every section, especially the family account number and employee signature, is completed. Missing information can delay the processing of the application.

Incorrect Employer Details: Providing inaccurate information about the employer can lead to complications. Double-check the employer’s name, title, and contact information to ensure accuracy.

Failure to Sign: Both the employee and employer must sign the form. Neglecting to include signatures can render the form invalid, necessitating resubmission.

Not Specifying Pay Frequency: It’s essential to clearly indicate how often the employee is paid. Omitting this detail can create confusion regarding income calculations.

Missing Hours Worked: Some applicants overlook detailing the number of hours and days worked per week. This information is crucial for determining eligibility and must be accurately reported.

Ignoring Instructions: The form includes specific directions for both employees and employers. Failing to follow these instructions can lead to errors and delays. Always read the guidelines carefully before submitting.