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Florida Administrative Code (Last Updated: April 18, 2024) |
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38. Department of Labor and Employment Security |
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38K. Division of Blind Services |
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38K-1. Blind Services |
1Forms and instructions used by the Division of Blind Services, Department of Labor and Employment Security, in its dealings with the public are prescribed and listed below. These forms and instructions are hereby incorporated and made a part of this rule. A copy of any form may be obtained without cost upon request to the Division of Blind Services, Department of Labor and Employment Security, 2540 Executive Center Circle, West, Suite 203, Tallahassee, FL 32399-2950. When requesting a specific form, reference should be made to the form number and title.
91DBS-001 (7/81)
93Referral and Application for Services (99413.011, F.S.101)
102DBS-002 (7/81)
104Application for Identification Card (109413.091, F.S.111)
112DBS-003 (7/81)
114Physician’s Report on Eye Condition (120413.011, F.S.122)
123DBS-004 (7/81)
125General Medical Examination Report (130413.011, F.S.132)
133DBS-005 (7/81)
135Case Summary For Medical Consultant (141413.011, F.S.143)
144DBS-006 (7/81)
146Final Report on Result of Operation Sight Restoration or Prevention of Blindness (159413.011, F.S.161)
162DBS-007 (8/81)
164Application for Services Based on Economic Need (172413.011, F.S.174)
175DBS-008 (7/81)
177Referral to Rehabilitation Facility (182413.011, F.S.184)
185DBS-009 (7/81)
187Dental Examination Report (191413.011, F.S.193)
194DBS-010 (7/81)
196Referral to Eye Clinic (201413.011, F.S.203)
204DBS-011 (7/81)
206Client Transportation (209413.011, F.S.211)
212DBS-016 (8/81)
214Invoice for Glasses (218413.011, F.S.220)
221DBS-017 (11/81)
223Consent for Release of Information (229413.011, F.S.231)
232DBS-022 (4/82)
234Facility Expenditure Report (238413.011, F.S.240)
241DBS-023 (4/82)
243Facility Utilization Report (247413.011, F.S.249)
250DBS-100 (12/81)
252Authorization and Billing Invoice (Client Services Vocational Rehabilitation Program) (262413.011, F.S.264)
265DBS-101 (7/81)
267Individualized Written Rehabilitation Program (272413.011, F.S.274)
275DBS-101a (7/81)
277Individualized Written Rehabilitation Program – Service Agreement (285413.011, F.S.287)
288DBS-103 (5/82)
290Referral for Vocational Rehabilitation (295413.011, F.S.297)
298DBS-104 (7/81)
300Client Service Log (304413.011, F.S.306)
307DBS-106 (12/81)
309Training Progress Report (313413.011, F.S.315)
316DBS-107 (7/81)
318Maintenance Invoice (321413.011, F.S.323)
324DBS-108 (8/82)
326Client Equipment Receipt & Inventory Record (333413.011, F.S.335)
336DBS-200 (12/81)
338Authorization and Billing Invoice (Client Services Medical and Social Services Program) (350413.011, F.S.352)
353DBS-201 (7/81)
355Medical and Social Services Rehabilitation Plan (362413.011, F.S.364)
365DBS-203 (7/81)
367Application for Preschool Program (372413.011, F.S.374)
375DBS-210 (7/81)
377Title XX – Right to Appeal (384413.011, F.S.386)
387DBS-501 (3/83)
389Notice of Appointment (393413.011, F.S.395)
396DBS-502 (3/83)
398Certification of Legal Blindness Notice (404413.011, F.S.406)
407DBS-503 (3/83)
409Notice of Missed Appointment (414413.011, F.S.416)
417DBS-701 (10/81)
419Monthly Supervision Report (423413.051, F.S.425)
426DBS-703 (10/81)
428Employee Personal Data (432413.051, F.S.434)
435DBS-704 (10/81)
437Drivers License (Turn-in) Form (442413.011, F.S.444)
445DBS-706 (10/81)
447Statement of Written Guidelines (452413.051, F.S.454)
455DBS-710 (10/81)
457Petty Cash Receipt (461413.051, F.S.463)
464Specific Authority 46620.05(1), 46720.15(7), 468120.53(1)(b), 469229.053(1), 470413.011(1)(m) FS. 472Law Implemented 47420.05(1), 47520.15(7), 476120.53(1)(b), 477413.011, 478413.051, 479413.091 FS. 481History–New 6-28-83, Formerly 6A-18.15, 6A-18.015.
