Florida Department of State and Division of Library and Information Services
Notice: 31280286
Final Adopted Version in F.A.C.
Department: DEPARTMENT OF FINANCIAL SERVICES
Division: Division of Risk Management
Chapter: STATE RISK MANAGEMENT TRUST FUND, STATE CASUALTY CLAIMS

VIEW NOTICE

Overview
RULE:
69H-2.008   Other Forms Adopted
RULE FILE DATE: 8/19/2026
RULE EFFECTIVE DATE: 9/8/2026
HISTORY NOTES: Rulemaking Authority 284.17, 284.39 FS. Law Implemented 284.30, 284.40, 284.41, 627.4137 FS. History–New 1-7-92, Amended 6-28-01, Formerly 4H-2.008, Amended 7-4-04, 5-4-05, 10-5-09, 1-9-11, 7-18-23, 9-8-26.
OVERSIGHT COMMITTEE: Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)
RELATED COURT CASES: Division of Administrative Hearings
FEDERAL RULES
AND REGULATIONS: 		Electronic Code of Federal Regulations
HOW TO LINK TO
THIS NOTICE: 		http://flrules.org/gateway/ruleno.asp?id=69H-2.008&Section=0
REFERENCE MATERIALS: Ref-15477 DFS-D0-280 Release of All Claims
Ref-15484 DFS-D0-866 Mileage Reimbursement
Ref-15487 DFS-D0-1403 General Liability Loss Report
Ref-15488 DFS-D0-1408 Release for Property Damage Only
Ref-15489 DFS-D0-1990 Medicare Secondary Payer Reporting Questionnaire
Ref-15490 DFS-D0-1991 Medicare Beneficiary Eligibility Information
Ref-15491 DFS-D0-1992 Firefighter Cancer Benefit Information Form
Ref-19348 DFS-D0-1406 - Insurer’s Disclosure Statement Pursuant to Section 627.4137, F.S.
Ref-19349 DFS-D0-1404 - Lien Disclosure Statement
Ref-19350 DFS-D0-1407 - Medical Authorization


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