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A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L.BUTLER,CLERK Program commitment, FPL reserves the right to pursue return of payment from the customer for any charges related to the fraud or service tampering activity. None of those charges can be paid for by FPL Care To Share Program funds. II. FPL Care To Share Application, Documentation and Records Retention 1. Caseworkers will ask the applicant to sign an Authorization for Release of General and/or Confidential Information form and retain that signed original. 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 client's verbal approval was obtained. 2. Caseworkers will use the Agency's standard intake form for the FPL Care To Share program. 3. Caseworkers will record the applicant's proof of crisis and plan to sustain future bills. 4. Caseworkers will secure and retain a copy of the applicant's actual bill (or FPL bill statement provided through the FPL ASSIST Web Portal or by FPL staff), notating the balance eligible for the program. Balance should be verified through the FPL ASSIST Web Portal. 5. Regarding income, caseworkers will: a. Use potential recipient's current participation in Temporary Assistance for Needy Families (TANF), Medicaid, Supplemental Security Income (S.S.I.), food stamps, and public housing for means testing. b. Verify and record "self-declaration" of recipient's income based on established Agency guidelines to limit inappropriate disbursements. 6. If a call to the FPL ASSIST Office is needed to qualify the applicant, caseworkers will note the date of the call and the first name of the FPL ASSIST representative who handled the call. In most cases, caseworkers should be able to use the FPL ASSIST Web Portal to qualify the applicant and make a commitment. The use of the FPL ASSIST Web Portal should then be noted. 7. Caseworkers will retain all approved applications, disapproved applications, and other pertinent records described in this section, for a period of three calendar years plus the current calendar year. 8. Caseworkers will maintain a list of retracted commitments, indicating reason for retraction and when FPL was notified. III. FPL Care To Share Payment Requirements 1. All FPL charges with the exception of deposits, non-electric optional products and services, return check fees, and additional billings resulting from service tampering (non-inherited current diversion charges) are eligible for the program. � 4 � FPL Care To Share Program Agreement(rev 11-27-2023)