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Click ‘Get Form’ to open the AHCA Form 3100 0008 in the editor.
Begin by entering your name in the 'Employee/Contractor Name' field. Ensure that it matches your official identification.
Next, fill in the 'Health Care Provider/Employer Name' and their address. This information is crucial for compliance.
In the attestation section, confirm that you meet employment requirements and have not been arrested for any disqualifying offenses as listed. You may need to refer to the specific statutes mentioned.
If applicable, indicate if you have been granted an Exemption from Disqualification and provide the date of decision.
For prior Level 2 screening evidence, complete the relevant fields regarding previous screenings and attach necessary documents.
Finally, sign and date the form at the bottom to validate your attestation before submitting it.
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What are the disqualifying offenses for AHCA background screening?
Disqualifying Offenses Certain offenses can disqualify individuals from employment in AHCA and DCF-regulated facilities. Disqualifying offenses include a range of serious crimes, such as: Violent Crimes: , manslaughter, aggravated assault, and aggravated battery.
What is the AHCA in Florida?
Florida Agency for Health Care Administration.
How do I get an AHCA level 2 background check in Florida?
All Level 2 screening requests must be submitted electronically. There are many Livescan sites available around the state from service providers listed on the FDLE site - some who offer mobile services for onsite screening.
What is the AHCA attestation form in Florida?
Get the up-to-date ahca form 3100 0008-2025 now. The document is an Attestation of Compliance form for employees in Florida, confirming their adherence to Level 2 background screening requirements as mandated by state statutes.
Who needs an AHCA license in Florida?
AHCA License Requirements The types of facilities that fall under AHCA regulation include hospitals, nursing homes, assisted living facilities, and home health agencies. The AHCA license application process involves a thorough evaluation of the facilitys compliance with state regulations.
attestation of compliance with background screening requirements
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Dec 18, 2025 AHCA or its designated contractor shall: 1. Determine the need for on-site full scope audits and determine the scope and format for such auditsRead more
Fla. Admin. Code Ann. R. 59A-35.090 - Background Screening
(d) Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, July 2024, herein incorporated by reference, must be completed byRead more
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