The purpose of the proposed amendment is to revise DWC 250, Notice of Election to Be Exempt, and its accompanying instructions, to adopt DWC 252, Certificate of Election to Be Exempt, and to update addresses for field offices for the Division of ...

 

DEPARTMENT OF FINANCIAL SERVICES
Divsion of Worker's Compensation

RULE NO: RULE TITLE
69L-6.009: Forms and Instructions
PURPOSE AND EFFECT: The purpose of the proposed amendment is to revise DWC 250, Notice of Election to Be Exempt, and its accompanying instructions, to adopt DWC 252, Certificate of Election to Be Exempt, and to update addresses for field offices for the Division of Workers’ Compensation’s Bureau of Compliance. The amendment revises Section 4 of both the form and instructions, deleting a request for an applicant’s “Business Mailing Address” and replacing it with a request for an “Address of Record”. The effect of the amendment is to provide additional guidance to applicants regarding the necessity of maintaining a consistent and reliable address for the purpose of receiving time-sensitive legal notices, documents, and communications from the Department, and to advise the public of correct field office information for the Division of Workers’ Compensation’s Bureau of Compliance.
SUMMARY: Updates Form DWC-250 and its instructions, and field office addresses of the Division of Workers’ Compensation’s Bureau of Compliance.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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: 440.05, 440.591 FS.
LAW IMPLEMENTED: 440.05 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Tuesday, October 16, 2007, 10:00a.m.
PLACE: Room 104J, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Andrew Sabolic, phone [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Andrew Sabolic, Assistant Division Director, Division of Worker’s Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4229, phone [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-6.009 Forms and Instructions.

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

(a) DWC 250 Notice of Election to be Exempt, (eff. ____2/07); and instructions for same (Instructions for Completing Notice of Election to be Exempt, (eff. ____2/07).

(b) DWC 250-R Revocation of Election to be Exempt, revised 2/00.

(c) DWC 251 Notice of Election of Coverage, revised 2/00.

(d) DWC 251-R Revocation of Election of Coverage, revised 2/00.

(e) DWC 252 Certificate of Election to be Exempt, (eff. _______).

(2) The forms may be obtained from the Bureau of Compliance, Division of Workers’ Compensation website at: www.fldfs.com/WC/ or from any field office, unless otherwise limited to direct issuance by the Division. The forms may be obtained from any field office of the Division of Workers’ Compensation, Bureau of Compliance.

(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 [phone]
Telephone [phone]
	3111 South Dixie Highway
2012 Capital Circle, S. E.	Suite 123
Suite 102, Hartman Bldg.	West Palm Beach, FL 33405
Tallahassee, FL 32399-2161	Telephone [phone]
Telephone [phone]
	4415 Metro Parkway
610 East Burgess Road	Suite #300
Pensacola, FL 32504-6320	Ft. Myers, FL 33916
Telephone [phone]	Telephone [phone]
499 N.W. 70th Avenue	Live Oak Business Center 1718 Main Street
Suite 116	5969 Cattlemen Lane Suite #201
Plantation, FL 33317	Sarasota, FL 342326
Telephone [phone]	Telephone [phone]-6042
1313 North Tampa Street	401 N.W. 2nd Avenue
Suite 503	South Tower, Suite 321
Tampa, FL 33602	Miami, FL 33128
Telephone [phone]	Telephone [phone]
400 West Robinson Street
Suite AN 512, North Tower
Orlando, FL 32801
Telephone [phone] or [phone]

 

Specific Authority 440.05, 440.591 FS. Law Implemented 440.05 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 2-19-07,_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Andrew Sabolic
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Tanner Holloman
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: July 10, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 27, 2007