WTP Opt Off Form

WTP Opt Off Form

I,

understand my options and opt not to receive TANF (assistance at this time). I would like to continue receiving Food Stamps and Medicaid for my family and myself.

To ensure your request to “Opt Off” cash assistance is received by the Department of Children and Families (DCF), you must return this signed form with your case # to the DCF ACCESS office whether in person or via fax (561) 882-3575 and you must do one of the following actions:

  1. Visit www.myflorida.com/accessflorida to complete a Change Request or
  2. Call 1-866-76-ACCESS (1-866-762-2237) and inform them that you choose not to receive any Cash Assistance at this time.
Sign Here
An equal opportunity/employer program. Auxiliary aids and services are available upon request to individuals with disabilities.