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Eligibility Requirements

Persons who wish to apply must meet ALL of the following eligibility criteria:

  • Must be at least 18 years of age.
  • Must be a U.S. Citizen or Legal Permanent Resident of the United States.
  • Must be a Florida resident.
  • Must be employed in Florida or in a county contiguous with the Florida border.
  • Must earn an annual gross income of at least the Individual Federal Poverty Level (2015 is $11,770) and not more than $120,000.
  • Must NOT receive cash benefits from Social Security Income (SSI) or Social Security Disability Income (SSDI).
  • Must not receive Medicaid Waiver.
  • Must be a person with disabilities who requires personal assistance service (PAS) for support or cueing for at least two activities of daily living such as, but not limited to ambulation, bathing, dressing, eating, grooming, and toileting, etc. (F.S. 429.02).
  • Must be able to acquire and manage a personal care attendant.
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Participant Forms


These forms are are available only to those where approved to participate in the program:

Monthly Reimbursement Documents

Reimbursement Request Form (.docx)

Reimbursement Request Form - Fillable (.pdf)
(This pdf version can be edited on screen)

Proof of Payment Form (.docx) (.pdf)

PCA Timesheet (.xlsx)

Additional Resources

JPPAS Policies & Procedures

Direct Deposit Authorization Form

PCA Tax Payment Reporting Form

Household Employer's Tax Guide 2016

Personal Care Attendant Handbook

Sample Job Description

Sample Contract/Agreement