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Application Process

Applications are available at physician's offices, the Department of Health, the Department of Children and Families, and other qualifying pregnancy testing centers. 

You may also schedule and attend an appointment with the Orange County Health Department's Eligibility Office to determine eligibility. This will give you an opportunity to learn about your options and other plans available. Bring the same items with you that you would need for completing the application as listed below.

The application process is simple. Just fill out a one page application form and provide the necessary documentation and you will receive notification of eligibility within 10 business days.

Application:
English (PDF324 kb) | Spanish (PDF 306kb) | Creole (PDF 321kb)

What to include with your application or bring with you to your appointment for eligibility:

• Proof of your U.S. citizenship (birth certificate) or non-citizen status
• Proof of identity (driver’s license)
• Proof of pregnancy, including the number of babies expected and the estimated due date. This cannot be more than 14 days old and must be on official letterhead.
• Your Social Security number
• Proof of Florida residency
  
• Proof of the last 4 weeks of gross income (before deductions) for all household members
• Other health insurance coverage, if any

When applying don't forget to:

• Fill out applicant information in full. Answer questions 1-10 completely. Do not omit any information or skip any questions or approval of the application will be delayed or denied.
• Sign the form!
• Attach your positive pregnancy test results from a health professional's office to the application.
• Affix postage and mail the application to the Department of Children and Families for the county where you live.

More to know for your application process:

• Contact Information - List a current working phone number and alternate phone number (can be a cell phone), where you can be reached to receive additional information.
• Other Income to Report - It is important to include the Social Security Number of the pregnant woman and the husband or father of the baby, if he lives in the home with the pregnant woman. Also include any Social Security or Child Support Income or Payments received for the other children of the pregnant woman that also live in the home.
• Pregnant Woman Under 21 - If the pregnant woman resides with her parents, caretakers or guardians list their names as well.