Florida Department of State and Division of Library and Information Services

Reference: Ref-09106

Reference Name: Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, January 2017
Agency: 59 Agency for Health Care Administration
59A Health Facility and Agency Licensing

Modified Document(s):
5/22/2018 The form is missing (f) under Criminal offenses found in section 435.04,F.S. This form corrects that.
Adopted Document(s):
1/19/2018 Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, January 2017
Proposed Document(s):
1/19/2018 Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, January 2017
Description: Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008, January 2017

Disclaimer: External links within the reference material are subject to change outside of the rulemaking process.

Rules/Notices using this Reference Material
Notice /
Adopted		 Section Description ID Publish
Date
View Text Proposed
59A-35.090 		The Agency proposes to amend Rule 59A-35.090 to align with 2024-243 LOF regarding background screening requirements, as well as update the Background Screening Application for Exemption, AHCA Form 3110-0019, and the Attestation .... 29071402 12/16/2024
Vol. 50/243
View Text Final
59A-35.090 		Background Screening. 20007237 Effective:
02/13/2018



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