69L-6.009: Forms and Instructions
PURPOSE AND EFFECT: The purpose of this amendment is to update Form DWC-250, Notice of Election to be Exempt, and its instructions, so that applicants are provided an area where they may supply the Division with an e-mail address. The amendment also updates current addresses for field offices of the Division of Workers' Compensation’s Bureau of Compliance. The effect of the amendment is to expand options for communication between the Division and applicants, and update field office addresses.
SUMMARY: Form DWC-250, and its instructions, and field office addresses of the Division of Workers’ Compensation’s Bureau of Compliance.
SUMMARY 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, FS., 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):
TIME AND DATE: Tuesday, September 12, 2006, 11:00 am
PLACE: Room 104J Hartman Building, 2012 Capital Circle SE, 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: Andrew Sabolic, Bureau Chief, Bureau of Compliance, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4228, phone 850-413-1600. 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: Andrew Sabolic, Bureau Chief, Bureau of Compliance, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4228, phone 850-413-1600.
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, revised 5/06
9/01; and instructions for same (Instructions for Completing Notice of Election to be Exempt, revised 5/06 Construction Industry Instructions for DWC 250, revised 9/01 and Non-Construction Industry Instructions for DWC 250, revised 2/00).
(b) DWC 250-R Revocation of Election to be Exempt, revised 2/00.
(c) DWC 251 Notice of Election of Coverage, revised 2/00.
(d) DWC 251-R revocation of Election of Coverage, revised 2/00.
(2) The forms may be obtained from any field office of the Division of Workers’ Compensation, Bureau of Compliance.
(3) The field offices of the Division of Workers’ Compensation, Bureau of Compliance, are:
Specific Authority 440.05,FS.,
440.05(9), 440.10, 440.185(7), 440.42(2), 440.591, 440.593 FS. Law Implemented 440.05 FS. , 440.103, 440.185(7), (9), 440.38(2), 440.42(2), 440.593 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 ________.