Notice of Proposed Rule

DEPARTMENT OF FINANCIAL SERVICES
Division of Worker's Compensation
RULE NO: RULE TITLE
69L-6.009: Forms and Instructions
PURPOSE AND EFFECT: To revise the following forms to comply with Section 119.071(5), F.S. (2007), that precludes an agency from requesting an individual’s social security number unless such collection conforms to the specified provisions of that statute. The following forms are revised: Form DWC 250 (Notice of Election to be Exempt), is amended to include a purpose and use statement regarding the collection of the social security number; Form DWC 250-R (Notice of Revocation of Election to be Exempt), DWC 251 (Notice of Election of Coverage), and DWC 251-R (Revocation of Election of Coverage), are amended so that the collection of the social security number is discontinued. This amendment also makes a clerical revision to the existing rule relating to a field office address.
SUMMARY: Revision of forms to eliminate the collection of social security numbers.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 440.05(9), 440.591 FS.
LAW IMPLEMENTED: 440.05 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Wednesday, October 8, 2008, 10:00 a.m.
PLACE: 104J, Hartman Building, 2012 Capital Circle S.E., Tallahassee, Florida
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Tasha Carter (850)413-1878. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Tasha Carter, Bureau Chief, Bureau of Compliance, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4228, phone (850)413-1878

THE FULL TEXT OF THE PROPOSED RULE IS:

69L-6.009 Forms and Instructions.

(1) The following forms are hereby adopted for use in connection with these rules:

(a) DWC 250 Notice of Election to be Exempt, (eff. _____1/08); and instructions for same (Instructions for Completing Notice of Election to be Exempt, (eff. _____1/08).

(b) DWC 250-R Revocation of Election to be Exempt, eff. revised _____2/00.

(c) DWC 251 Notice of Election of Coverage, eff. revised _____2/00.

(d) DWC 251-R Revocation of Election of Coverage, eff. revised _____2/00.

(e) DWC 252, Certificate of Election to be Exempt, (eff. 1/08).

(2) The forms may be obtained from the Bureau of Compliance, Division of Workers’ Compensation website at: www.fldfs.com/WC/ or from any field office, unless otherwise limited to direct issuance by the Division.

(3) The field offices of the Division of Workers’ Compensation, Bureau of Compliance, are:

921 North Davis Street, Building B

1111 N. E. 25th Avenue, Suite 403

Suite 250

Ocala, FL 34470

Jacksonville, FL 32209

Telephone (352)401-5350

Telephone (904)798-5806

 

 

 

2012 Capital Circle, S. E.

3111 South Dixie Highway

Suite 106102, Hartman Bldg.

Suite 123

Tallahassee, FL 32399-2161

West Palm Beach, FL 33405

Telephone (850)413-1609

Telephone (561)837-5716

 

 

610 East Burgess Road

4415 Metro Parkway

Pensacola, FL 32504-6320

Suite #300

Telephone (850)453-7804

Ft. Myers, FL 33916

 

Telephone (239)938-1840

 

 

499 N.W. 70th Avenue

Live Oak Business Center

Suite 116

5969 Cattlemen Lane

Plantation, FL 33317

Sarasota, FL 34232

Telephone (954)321-2906

Telephone (941)329-1120

 

 

1313 North Tampa Street

401 N.W. 2nd Avenue

Suite 503

South Tower, Suite 321

Tampa, FL 33602

Miami, FL 33128

Telephone (813)221-6506

Telephone (305)536-0306

 

 

400 West Robinson Street

 

Suite N 512, North Tower

 

Orlando, FL 32801

 

Telephone (407)835-4406 or (407)245-0896

 

 

Specific Authority 440.05(9), 440.591, FS. Law Implemented 440.05, FS. History-New 11-20-79, Amended 4-15-81, 1-2-86, Formerly 38F-6.09, Amended 5-28-91, 2-15-94, 2-2-00, 3-5-02, Formerly 38F-6.009, 4L-6.009, Amended 2-19-07, 1-7-08,__________.


NAME OF PERSON ORIGINATING PROPOSED RULE: Tasha Carter, Bureau Chief, Bureau of Compliance, Division of Workers’ Compensation
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Tanner Holloman, Division Director, Division of Workers’ Compensation
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 30, 2008
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 18, 2008