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