The Board proposes the rule amendment to modify the Application form.

DEPARTMENT OF HEALTH
Board of Psychology

RULE NO: RULE TITLE
64B19-11.012: Application Forms
PURPOSE AND EFFECT: The Board proposes the rule amendment to modify the Application form.
SUMMARY: The rule amendment will modify the Application form.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: A Statement of Estimated Regulatory Cost was prepared and voted upon. The Board determined that small businesses would not be affected by this rule. However, a Statement of Estimated Regulatory Cost was prepared for review.
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: 490.004(4) FS.
LAW IMPLEMENTED: 490.005, 490.006(1)(b) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Allen Hall, Executive Director, Board of Psychology/MQA, 4052 Bald Cypress Way, Bin #C05, Tallahassee, Florida 32399-3255

THE FULL TEXT OF THE PROPOSED RULE IS:

64B19-11.012 Application Forms.

(1) All applicants for licensure pursuant to Chapter 490, F.S., shall complete and submit form DH-MQA 1187, (Revised 9/09 1/09), “Application for Psychologist Licensure,” effective 1-23-09, which is incorporated herein by reference and which be obtained from the Board office or on the Board’s website at http://www.doh.state.fl.us/mqa/psychology.

(2) through (4) No change.

Rulemaking Authority 490.004(4) FS. Law Implemented 490.005, 490.006(1)(b) FS. History–New 6-25-02, Amended 5-24-09, ________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Psychology
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Psychology
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: September 25, 2009
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 24, 2009