Worker Information Name Florida User ID Case Information Case Number Name of Customer Sanction Effective Date Exemption Exemption Code Start Date Exception Exception Code Start Date Good Cause Good Cause Reason Code Start Date Employment If the customer is working, include the information below: Name of Employer Date the customer started working Date of 1st Check Number of Hours Rate of Pay Frequency of Pay -- Select --WeeklyBi-WeeklyMonthly Volunteer If the customer is volunteering, include the information below: Name of Agency where customer is volunteering Date customer started volunteering Number of Hours In-Kind Work If the customer has in-kind work, include the information below: Type of In-Kind Work Date customer started in-kind work $$ Amount in-kind work Submit