69L-10.019. Forms

Effective on Monday, March 16, 2009

1The following forms are incorporated by reference into these rules and are available from and shall be filed with: SDTF, Division of Workers’ Compensation, 200 East Gaines Street, Tallahassee, FL 32399-4223.

32(1) DFS Form 35DFS-F1-36SDF-1 – Proof of Claim (Rev. 423-0943).

44(2) DFS Form 47DFS-F1-48SDF-2 –Reimbursement 50Request 51(Rev. 3/530549).
55Specific Authority 57440.4958(7), 59440.591 60FS. Law Implemented 63440.49 FS. 65History–New 4-19-92, Amended 8-18-93, 69Formerly 38F-10.019, 4L-10.019, Amended 3-16-09.

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