1. (1) The Program shall only require that applicants provide the following information:

   1. (a) For the Beneficiary, Administrator, and Authorized Signatory:

      1. Full legal name, including salutation and suffix;

      2. Social Security Number;

      3. Date of birth;

      4. Two mailing addresses;

      5. Two telephone numbers;

      6. Two e-mail addresses;

      7. Relationship to Beneficiary; and,

      8. Contact preferences.

   2. (b) The Future Contribution Allocation.
   3. (c) The source and amount of any initial contribution and Rollover Contribution.

   4. (d) Marketing Information for the Beneficiary, Administrator, and Authorized Signatory:

      1. How did you hear about the Program?

      2. Annual Family or Household Income;

      3. Gender;

      4. Race;

      5. Primary language;

      6. Level of education; and,

      7. Types of federal and state benefits currently received or applied for.

   5. (e) Information required for the processing of a one-time and recurring automatic contribution authorization.
   6. (f) Information required to determine basis of Beneficiary’s eligibility for an ABLE Account.
   7. (g) Information required by the Participation Agreement and Terms and Conditions.
   8. (h) Information required by the Secretary of the Treasury or Commissioner of Social Security.
2. (2) A copy of the Participation Agreement, Terms and Conditions, and Application may be obtained from the Board by submitting a request for these documents to: P. O. Box 6448, Tallahassee, Florida 32314-6448.

Rulemaking Authority 1009.971(1), (4), 1009.986(10) FS. Law Implemented 1009.986 FS. History–New 6-23-16.