Florida kidcare income verification form 2026

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The document is an Employment Statement form for Florida KidCare, which must be completed by employers to verify income for family members applying for KidCare health insurance. It includes sections for employee authorization and employer information regarding hours worked, pay frequency, gross pay rate, and a statement of truth from the employer.

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Click ‘Get Form’ to open the Florida KidCare Income Verification Form in the editor.
In Section A, enter your Family Account Number and provide your name and Social Security Number. Sign and date the authorization for release of employment information.
Submit Section A to your employer for completion. Ensure they fill out Section B accurately, providing details such as hours worked per week, pay frequency, and gross pay rate.
Ask your employer to include any variations in hours or pay rates, along with a statement confirming the accuracy of the information provided.
Once completed, ensure that your employer signs the form and includes their title, contact number, business name, and address before returning it to Florida KidCare.

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