Notice of Case Action

ACCESS CENTRAL MAIL CENTER

State of Florida Department
P.O. BOX 1770
of Children and Families
OCALA FL 34478

January 27, 2025 Case: 1696384168 Phone: (407 ) 317 - 7853

Fax : (866 ) 735 - 2469 ACCESS Number: 214250473

Nazmeen Sultana
6125 MELBOURNE AV
ORLANDO FL 32835

Dear Nazmeen Sultana,

The following is information about your eligibility.

Once you receive your case number you can go to www.myflorida.com/accessflorida to activate your My
ACCESS Account. You will be able to get case status information. You will also be able to print a temporary
Medicaid card if you are eligible for Medicaid.

We need the following information by February 06, 2025.

*Proof of loss of income, last pay date and all income received in the month of 01/2025 using the "Verification Of
Employment /Loss Of Income" form or provide a letter from your job
*Proof of all gross income from the last 4 weeks using the "Verification Of Employment/Loss Of Income" form or you
may send in your last 4 pay stubs
Other - please see comments below
YOUR EXPENSES EXCEED YOUR REPORTED AND/OR VERIFIED INCOME. IF RECEIVING MONETARY
CONTRIBUTIONS, THEN PLEASE PROVIDE A WRITTEN STATEMENT FROM ALL INDIVIDUALS HELPING YOU,
DETAILING THE SPECIFIC AMOUNT RECEIVED FOR THE LAST FOUR WEEKS. ALL LETTERS MUST BE
DATED, AND CONTAIN THE AUTHOR¿S DAYTIME PHONE NUMBER, ADDRESS, AND SIGNATURE. IF NO
ONE IS ASSISTING YOU, THEN PLEASE PROVIDE PROOF OF ALL HOUSEHOLD EXPENSES. THANK YOU!
Requested items with an asterisk (*) must be provided if you are applying for food assistance.
Please return or fax the information to the return address or fax number listed above. If you need help getting this
information, let us know right away.
If you do not contact us or provide the requested information, we will be unable to determine your eligibility. We will
deny your application or your benefits may end.

AE39 FORM : CF-ES 157 08 2008

DCF Services:
For information about your case, you may access your case information quickly and securely:
• through My ACCESS Account at www.myflorida.com/accessflorida,
• receive email notifications by signing up through your MyACCESS Account, or
• call the ACCESS Customer Call Center at (850) 300-4DCF (4323).
• For more information about Medicaid eligibility and applying for Medicaid, please go to
https://www.myflfamilies.com/medicaid .

Fair Hearings: If you disagree with our decision , you have the right to ask for a hearing before a state hearing
officer. You may be represented at the hearing by a lawyer, relative, friend, or anyone you choose. If you want a
hearing, you must ask for the hearing within 90 days from the date at the top of this notice. You may ask for a hearing
by emailing us at appeal.hearings@myflfamilies.com ; by making a request online at
https://www.myflfamilies.com/fairhearings ; by writing to us at Appeal Hearings Section, 2415 North Monroe Street, Suite
400-I, Tallahassee, Florida 32303-4190; by calling the call center; or by coming into a DCF office. If you ask for a
hearing before the date your benefits are scheduled to end or change, your Medicaid benefits will continue at the prior
level until the hearing decision; for all other programs, your benefits may continue at the prior level until the hearing
decision. You may be responsible to repay any benefits if the hearing decision is not in your favor. For Medicaid, you
will not be responsible to repay benefits unless we find that you engaged in fraud or an intentional program violation.
Your appeal will be decided within 90 days of your request. For Medicaid, if you have an urgent health care need (one
that would result in serious harm to your health if not treated soon), you can ask for a faster appeal. Proof of your urgent
health care need may be requested.

If you need information about free legal services, call the ACCESS Customer Call Center toll free at (850)
300-4DCF (4323) for a listing of legal services in your area or you can visit www.floridalawhelp.org.

Information on other services that may be helpful to you can be found at

https://www.myflfamilies.com/services/public-assistance .
Local community partner agencies are available to help you apply for services. To find one near you, go to
www.myflorida.com/accessflorida under “Find Us”. You can search by zip code or county.

Other information that may help you:

• To register or update your voter registration, you can visit www.registertovoteflorida.gov or call the ACCESS
Customer Call Center at (850) 300-4DCF (4323)
• Did you earn less than $66,819 in 2024? You may be eligible for an Earned Income Tax Credit up to $7,830. For
more information on where to find free tax assistance in your area call the IRS at 1-800-829-1040.
• You may be eligible to receive monthly discounts on your phone bill through Florida’s Lifeline Assistance
Program. Call your phone company or the Florida Public Service Commission at 1-800-342-3552 for more
information.
• If you need free help obtaining child support, medical support, establishing paternity, or locating your child’s
parent, call the Florida Child Support Program at (850) 488-KIDS (5437).

For Florida Relay 711 or TTY services, call 1-800-955-8771.

Nondiscrimination Policy:
In accordance with federal civil rights laws and U.S. Department of Agriculture (USDA) civil rights regulations and
policies, the USDA, its agencies, offices, and employees, and institutions participating in or administering USDA
programs are prohibited from discriminating based on race, color, national origin, sex (including gender identity and
sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity in
any program or activity conducted or funded by USDA. Programs that receive federal financial assistance from the U.S.
Department of Health and Human Services (HHS), such as Temporary Assistance for Needy Families (TANF), and
programs HHS directly operates are also prohibited from discrimination under federal civil rights laws and HHS
regulations.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the agency (state or local) where they applied for benefits.
Individuals who are deaf, hard of hearing or who have speech disabilities may contact USDA through the Federal Relay
Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
CIVIL RIGHTS COMPLAINTS INVOLVING USDA PROGRAMS

USDA provides federal financial assistance for many food security and hunger reduction programs such as the
Supplemental Nutrition Assistance Program (SNAP), the Food Distribution Program on Indian Reservations (FDPIR)
and others. To file a program complaint of discrimination, complete the Program Discrimination Complaint Form,
(AD-3027) found online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf , and at any USDA office or
write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy
of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

1. mail: Food and Nutrition Service, USDA

1320 Braddock Place, Room 334, Alexandria, VA 22314; or
2. fax: (833) 256-1665 or (202) 690-7442; or
3. phone: (833) 620-1071; or
4. email: FNSCIVILRIGHTSCOMPLAINTS@usda.gov

For any other information regarding SNAP issues, persons should either contact the USDA SNAP hotline number at
(800) 221-5689, which is also in Spanish, or call the state information/hotline numbers (click the link for a listing of
hotline numbers by state); found online at: SNAP hotline.

CIVIL RIGHTS COMPLAINTS INVOLVING HHS PROGRAMS

HHS provides federal financial assistance for many programs to enhance health and well-being, including TANF, Head
Start, the Low Income Home Energy Assistance Program (LIHEAP), and others. If you believe that you have been
discriminated against because of your race, color, national origin, disability, age, sex (including pregnancy, sexual
orientation, and gender identity), or religion in programs or activities that HHS directly operates or to which HHS
provides federal financial assistance, you may file a complaint with the Office for Civil Rights (OCR) for yourself or for
someone else.
To file a complaint of discrimination for yourself or someone else regarding a program receiving federal financial
assistance through HHS, complete the form on line through OCR’s Complaint Portal at https://ocrportal.hhs.gov/ocr/ .
You may also contact OCR via mail at: Centralized Case Management Operations, U.S. Department of Health and
Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201; fax: (202)
619-3818; or email: OCRmail@hhs.gov . For faster processing, we encourage you to use the OCR online portal to file
complaints rather than filing via mail. Persons who need assistance with filing a civil rights complaint can email OCR at
OCRMail@hhs.gov or call OCR toll-free at 1-800-368-1019, TDD 1-800-537-7697. For persons who are deaf, hard of
hearing, or have speech difficulties, please dial 7-1-1 to access telecommunications relay services. We also provide
alternative formats (such as Braille and large print), auxiliary aids and language assistance services free of charge for
filing a complaint.
This institution is an equal opportunity provider.
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