Fla. Admin. Code Ann. R. 64W-6.003 - Documentation Requirements
(1)
FRAMEdental applicants must complete and submit the
following forms in the FRAMEworks portal:
(a) The Florida Reimbursement Assistance for
Medical Education - Dental (FRAMEdental)
Application. The FRAMEdental Application,
DH8017-PHSPM-07/2024 (07-2024), is incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-18037.
(b) The Florida Reimbursement Assistance for
Medical Education - Dental (FRAMEdental) Employment
Verification Form (PDF only). One form is required for each employer.
Signatures must be in ink. The FRAMEdental
Employment Verification Form, DH8018-PHSPM-07/2024 (07-2024), is
incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-18038.
(c) The Florida Reimbursement Assistance for
Medical Education - Dental (FRAMEdental) Loan
Certification Form for each qualified loan (PDF only). Signatures must be in
ink or utilize a legally binding eSignature. The FRAMEdental
Loan Certification Form, DH8019-PHSPM-07/2024 (07-2024), is
incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-18039.
(d) The Florida Reimbursement Assistance for
Medical Education - Dental (FRAMEdental) Volunteer Hours Verification Form for
any volunteer hours included in the application. The FRAMEdental Volunteer
Hours Verification Form, DH8021-PHSPM-07/2024 (07-2024), is incorporated by
reference and available at
https://flrules.org/Gateway/reference.asp?No=Ref-18040.
(e) The Florida Reimbursement
Assistance for Medical Education - Dental (FRAMEdental) Volunteer Service
Obligation Acknowledgment Form if the applicant has not completed 25 hours of
volunteer services prior to application. The FRAMEdental Volunteer Service
Obligation Acknowledgment Form, DH8023-PHSPM-09/2024 (09-2024), is incorporated
by reference and available at
https://flrules.org/Gateway/reference.asp?No=Ref-18041.
(2) The following HPSA
documentation must be uploaded to the FRAMEworks portal, as applicable:
(a) For all practice locations that are in an
FQHC; state or federal correctional facility; a rural health clinic; an Indian
Health Service, Tribal Health, or Urban Indian Health Organization; or a state
mental hospital, upload documentation of dental shortage designation status. 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 (2)(a) above, but are designated by HRSA as having a
shortage of dental health professionals based on geographic location, special
population, or facility, upload a PDF copy of the query result for each
practice site location from HRSA "Find Shortage Areas by Address" query result
for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address).
(3) If requested by the
Department, an applicant must provide 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 5 business days.
(4) The FRAMEdental
Employment Verification Form the
FRAMEdental Volunteer Hours Verification Form, the
FRAMEdental Volunteer Service Obligation
Acknowledgement Form, and the FRAMEdental Loan
Certification Form will be made available on the
FRAMEworks website at
https://www.fdohframe.com/s/forms.
(5) Dentists and dental hygienists who
received an award in a previous year may apply for recertification during each
application year meeting the same application requirements outlined in
subsections (1) through (3) above.
(6) This rule will be reviewed and repealed,
modified, or renewed through the rulemaking process 5 years from the effective
date.
Notes
Rulemaking Authority 381.4019 FS. Law Implemented 381.4019 FS.
New 2-15-24.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) FRAMEdental applicants must complete and submit the following forms in the FRAMEworks portal:
(a) The Florida Reimbursement Assistance for Medical Education - Dental (FRAMEdental) Application. The FRAMEdental Application, DH8017-PHSPM-07/2023, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-16373.
(b) The Florida Reimbursement Assistance for Medical Education - Dental (FRAMEdental) Employment Verification Form (PDF only). One form is required for each employer. Signatures must be in ink. The FRAMEdental Employment Verification Form, DH8018-PHSPM-07/2023, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-16374.
(c) The Florida Reimbursement Assistance for Medical Education - Dental (FRAMEdental) Loan Certification Form for each educational loan (PDF only). Signatures must be in ink or utilize a legally binding eSignature. The FRAMEdental Loan Certification Form, DH8019-PHSPM-07/2023, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-16375.
(2) The following document(s) must be uploaded to the FRAMEworks portal, as applicable:
(a) For all practice locations that are in an FQHC, upload documentation of dental shortage designation status. 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 in an FQHC, but are designated by HRSA as having a shortage of dental health professionals based on geographic location, special population, or facility, upload a PDF copy of the query result for each practice site location from HRSA "Find Shortage Areas by Address" query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address).
(3) If requested by the Department, an applicant must provide 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 5 business days.
(4) The FRAMEdental Employment Verification Form and the FRAMEdental Loan Certification Form will be made available on the Department's website at https://www.fdohframe.com/s/forms.
(5) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process 5 years from the effective date.
Notes
Rulemaking Authority 381.4019 FS. Law Implemented 381.4019 FS.
New 2-15-24.