Forms and Instructions  

  • DIVISION OF WORKERS’ COMPENSATION

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    RULE NO.:              RULE TITLE:

    69L-6.009Forms and Instructions

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    NOTICE OF CHANGE

    Notice is hereby given that the following changes have been made to the proposed 69L-6.009 in accordance with subparagraph 120.54(3)(d)1., F.S., published in Volume 32, No. 33, August 18, 2006, of the Florida Administrative Weekly.  These changes are being made to address comments expressed by the Joint Administrative Procedures Committee.

    69L-6.009

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

    (a) DWC 250 Notice of Election to be Exempt, (eff._____)revised 9/01; and instructions for same (Instructions for Completing Notice of Election to be Exempt, (eff._____)Construction Industry Instructions for DWC 250, revised 9/01 and Non-Construction Industry Instructions for DWC 250, revised 2/00).

    (b) - (d) No change

    (2) No change.

    (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 (850) 798-5806

     

    2012 Capital Circle, S. E. 2686 Chapman Drive

    Suite 102, Hartman Bldg. Panama City, FL 32405-4914

    Tallahassee, FL 32399-2161 Telephone (850) 747-5425

    Telephone (850) 413-1609

     

    610 East Burgess Road 3111 South Dixie Highway

    Pensacola, FL 32504-6320 Suite 123

    Telephone (850) 453-78047850 West Palm Beach, FL 33405

    Telephone (561) 837-57165412

     

    499 N.W. 70th Avenue 4415 Metro Parkway 12381 S. Cleveland Avenue

    Suite 116 Suite #300,Suite 506,

    Plantation, FL 33317 Ft. Myers, FL 3391607

    Telephone (954) 321-29063143Telephone (239) 938-1840278-7239

     

    1313 North Tampa Street 1718 Main Street

    Suite 503 Suite 201

    Tampa, FL 33602 Sarasota, FL 34236

    Telephone (813) 221-6506 Telephone (941) 361-6042

     

    400 West Robinson Street 401 N.W. 2nd Avenue

    Suite NRoom 512, North Tower South Tower, Suite 321

    Orlando, FL 32801 Miami, FL 33128

                  Telephone (407) 835-4406                                           Telephone (305) 536-0306

     

    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 ________.

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    The remainder of the reads as previously published.

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Document Information

Related Rules: (1)
69L-6.009. Forms and Instructions