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Information" form, in order to have access to FPL billing information. FPL reserves the right to request the Agency to provide copies of the forms as part of the program audit requirements. If telephone pre-screening is conducted, the caseworkers will review the ;information from the release form and seek the applicant's verbal approval to share information. Caseworker should note on the file that the applicant's verbal approval was obtained. The Agency shall ensure that no person shall be subjected to discrimination in connection with the FPL Care To Share program on the basis of age, gender, disability; race, color, creed, national origin, religion or ancestry contrary to applicable law. FPL customers who are potential recipients of FPL Care To Share funds shall have equal opportunity for assistance, and assistance remains available twelve months per year, as funding and resources permit. The eligibility criteria cannot be added to or deviated from without the prior consent of the FPL Area Manager. The Agency signing this Agreement does hereby bind itself to the following terms and conditions: 1. Eligibility Criteria Potential recipients must contact the administering Agency and follow the agency's intake process, which could include receiving preliminary screening and making an appointment with the Agency representative when appropriate. An eligible applicant is one who meets all the following criteria: 1. Must physically reside in FPL's service area at the address for which assistance is sought. 2. Must have an account with FPL or reside at the "service location. Should an Agency employee seek to apply for FPL Care To Share assistance through the Agency, an Agency supervisor - such as the. Primary or Alternate contact listed on FPL ASSIST Program record - must contact the FPL Area Manager in advance for approval and commitment placement. 3. Must have identification that reflects the applicant name and the same address as the FPL account. Some examples of acceptable identification include a driver's license, a rent receipt, a water or phone bill, a tax bill or a mortgage statement 4. Must have a delinquent or Past Due FPL bill, final notice, or disconnect notice for the FPL account. Current bill is also eligible, if Agency caseworker reasonably deems it appropriate. 5. Must NOT have received a benefit under the FPL Care To Share Program within the last twelve months -at the current service address. The initial commitment set - pp date is used to determine the 12 -month time period. 21 FPL Care To Share Program Agreement (rev 7-9-2016) 151