Section 64W-4.003 - Documentation Requirements(2) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Employment Verification Form must be uploaded to the FRAMEworks portal (PDF only). One form is required for each employer, including self-employment or partnerships. The FRAME Employment Verification Form, DH8015-PHSPM-01/2024, is incorporated by reference and available https://www.flrules.org/Gateway/reference.asp?No=Ref-16379. Signatures on this form must be in ink.(3) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Loan Certification Form for each educational loan must be uploaded to the FRAMEworks portal (PDF format only). The FRAME Loan Certification Form, DH8014-PHSPM-01/2024, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16378. Signatures must be in ink, except that the financial institution may utilize a legally binding eSignature.(4) The following FRAME program documents must be uploaded to the FRAMEworks portal, as applicable:(a) For all practice locations that are in an FQHC; correctional facility; a rural health clinic; an Indian Health Service, Tribal Health, and Urban Indian Health Organizations; or a state mental hospital, upload documentation of primary care shortage designation. A PDF copy of the HRSA "Find Shortage Areas State/County" query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/hpsa-find) is considered acceptable documentation.(b) For all practice locations that are not listed in paragraph (a) above, but are in a primary care HPSA, upload a PDF copy of the query result for each practice site location from the HRSA "Find Shortage Areas by Address" query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address).(c) For all practice locations that are not in a primary care HPSA but are in a designated rural health area or rural hospital, submit documentation of the rural health status. A PDF copy of the query result for each practice site location from the Federal Office of Rural Health Policy (https://data.hrsa.gov/tools/rural-health) is considered acceptable documentation.(d) If requested by the Department, PDF documentation of status as a United States citizen (U.S. born or naturalized) or United States national, as defined by 8 U.S.C. 1401 - 1440, shall be provided by the applicant within five (5) business days.(5) The FRAME Employment Verification Form and FRAME Loan Certification Form will also be made available on the Department's website at https://www.fdohframe.com/s/forms.(6) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.Fla. Admin. Code Ann. R. 64W-4.003
Rulemaking Authority 1009.65 FS. Law Implemented 1009.65 FS.
Adopted by Florida Register Volume 49, Number 065, April 4, 2023 effective 4/20/2023, Amended by Florida Register Volume 50, Number 020, January 30, 2024 effective 2/15/2024.New 4-20-23, Amended 2-15-24.