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Florida Administrative Code (Last Updated: April 18, 2024) |
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6. Department of Education |
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6A. State Board of Education |
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6A-22. Reemployment Services - Workers' Compensation |
1(1) Forms DWC-21, 4Reemployment Services Billing Form; 8DWC-22, 9Reemployment Status Review Form; DFS-F3-14DWC-23, 15Request for Screening; DFS-F3-19DWC-24 20Department and Student Agreement for Sponsorship of Training and Education; 30DWC-96, 31Qualified Rehabilitation Provider Application; File Layout for Electronic Submission, Revision A Record Length: 1000 Header Record Layout for DWC-22, and File Layout for Electronic Submission, Revision C Record Length: 1200 Header Record Layout for DWC-21 66and accompanying instructions are incorporated by reference as part of this rule to become effective 81with the effective date of this rule88. Each form shall be typed or legibly completed in order for the form to be considered properly filed or submitted with the Department.
112(a) 113The carrier shall submit the form DWC-21 to the 122Department.
123(b) Reemployment status review form shall be submitted to the Department on form DWC-22.
137(c) Request for screening form shall be submitted to the Department on Form DFS-F3-DWC-23.
151(d) Department and student agreement for sponsorship of training and education form shall be completed on Form DFS-F3-DWC-24.
169(e) Qualified rehabilitation provider application shall be submitted to the Department on form DWC-96.
183(2) A copy of the forms and accompanying instructions incorporated by subsection 1956A-22.011(1), 196F.A.C., may be obtained from the Department of Financial Services, Bureau of Employee Assistance and Ombudsman Office, 200 East Gaines Street, Tallahassee, Florida 32399-4225. Copies are also available at the following Department web site230: 231http://myfloridacfo.com/WC/forms.html232.
233Rulemaking Authority 235440.491(5), 236(6), (7), 238440.591 FS. 240Law Implemented 242440.491 FS. 244History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.014, Amended 5-5-04, 5-7-09, Formerly 2546A-22.011.
