 |
Florida Administrative Code (Last Updated: April 18, 2024) |
 |
6. Department of Education |
|
6A. State Board of Education |
|
6A-18. Division Of 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 (Section 99413.011, F.S.101)
102DBS-002 (7/81)
104Application for Identification Card (Section 109413.091, F.S.111)
112DBS-003 (7/81)
114Physician’s Report on Eye Condition (Section 120413.011, F.S.122)
123DBS-004 (7/81)
125General Medical Examination Report (Section 130413.011, F.S.132)
133DBS-005 (7/81)
135Case Summary For Medical Consultant (Section 141413.011, F.S.143)
144DBS-006 (7/81)
146Final Report on Result of Operation Sight Restoration or Prevention of Blindness (Section 159413.011, F.S.161)
162DBS-007 (8/81)
164Application for Services Based on Economic Need (Section 172413.011, F.S.174)
175DBS-008 (7/81)
177Referral to Rehabilitation Facility (Section 182413.011, F.S.184)
185DBS-009 (7/81)
187Dental Examination Report (Section 191413.011, F.S.193)
194DBS-010 (7/81)
196Referral to Eye Clinic (Section 201413.011, F.S.203)
204DBS-011 (7/81)
206Client Transportation (Section 209413.011, F.S.211)
212DBS-016 (8/81)
214Invoice for Glasses (Section 218413.011, F.S.220)
221DBS-017 (11/81)
223Consent for Release of Information (Section 229413.011, F.S.231)
232DBS-022 (4/82)
234Facility Expenditure Report (Section 238413.011, F.S.240)
241DBS-023 (4/82)
243Facility Utilization Report (Section 247413.011, F.S.249)
250DBS-100 (12/81)
252Authorization and Billing Invoice (Client Services Vocational Rehabilitation Program)
261(Section 262413.011, F.S.264)
265DBS-101 (7/81)
267Individualized Written Rehabilitation Program (Section 272413.011, F.S.274)
275DBS-101a (7/81)
277Individualized Written Rehabilitation Program – Service Agreement (Section 285413.011, F.S.287)
288DBS-103 (5/82)
290Referral for Vocational Rehabilitation (Section 295413.011, F.S.297)
298DBS-104 (7/81)
300Client Service Log (Section 304413.011, F.S.306)
307DBS-106 (12/81)
309Training Progress Report (Section 313413.011, F.S.315)
316DBS-107 (7/81)
318Maintenance Invoice (Section 321413.011, F.S.323)
324DBS-108 (8/82)
326Client Equipment Receipt & Inventory Record (Section 333413.011, F.S.335)
336DBS-200 (12/81)
338Authorization and Billing Invoice (Client Services Medical and Social Services Program)
349(Section 350413.011, F.S.352)
353DBS-201 (7/81)
355Medical and Social Services Rehabilitation Plan (Section 362413.011, F.S.364)
365DBS-203 (7/81)
367Application for Preschool Program (Section 372413.011, F.S.374)
375DBS-210 (7/81)
377Title XX – Right to Appeal (Section 384413.011, F.S.386)
387DBS-501 (3/83)
389Notice of Appointment (Section 393413.011, F.S.395)
396DBS-502 (3/83)
398Certification of Legal Blindness Notice (Section 404413.011, F.S.406)
407DBS-503 (3/83)
409Notice of Missed Appointment (Section 414413.011, F.S.416)
417DBS-701 (10/81)
419Monthly Supervision Report (Section 423413.051, F.S.425)
426DBS-703 (10/81)
428Employee Personal Data (Section 432413.051, F.S.434)
435DBS-704 (10/81)
437Drivers License (Turn-in) Form (Section 442413.011, F.S.444)
445DBS-706 (10/81)
447Statement of Written Guidelines (Section 452413.051, F.S.454)
455DBS-710 (10/81)
457Petty Cash Receipt (Section 461413.051, F.S.463)
464Rulemaking 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, 48638K-1.015.
