REQUEST FOR PROOF OF IDENTITY
REQUEST FOR PROOF OF IDENTITY FOR A CHILD UNDER AGE 16
(Cannot be used if an attestation was used to document citizenship.)
If no other documentation of identity is available for the child (such as daycare or school records,
or a photo ID), use this form for verification of identity for each child under the age of 16, who is applying
for, receiving KidCare.
Please Note: A birth certificate or Social Security card cannot be used for identity.
Please return the completed form to Florida KidCare, PO Box 591, Tallahassee, Florida 32302-0591.
If you have any questions, please call Florida KidCare toll free at 1-800-821-5437.
Family Account Number: __________________________
1. My name is ______________________________________________________________________
I am the parent/guardian/representative of:
Child #1: Legal name: _________________________________________________________________
Date of birth: _____________________________
State of bi