Fla. Admin. Code Ann. R. 69L-22.011 - List of Forms

(1) The following forms are to be used with this rule chapter and are hereby incorporated by reference:

(a) Form DFS-F3-DWC-23 http://www.flrules.org/Gateway/reference.asp?No=Ref-06694 (Revised: 12/2015), Request for Screening;

(b) Form DFS-F3-DWC-24 http://www.flrules.org/Gateway/reference.asp?No=Ref-06695 (Revised: 12/2015), Department and Student Agreement for Sponsorship of Training and Education;

(c) Form DFS-F3-DWC-26 http://www.flrules.org/Gateway/reference.asp?No=Ref-06696 (Effective: 12/2015), Department and Injured Employee Agreement for the Provision of Contracted Placement Services;

(d) Form DFS-F3-DWC-27 http://www.flrules.org/Gateway/reference.asp?No=Ref-06697 (Effective: 12/2015), Reemployment Services Questionnaire.

(2) Copies of the above forms are available on the Department's web site at: http://www.myfloridacfo.com/Division/wc/.

Notes

Fla. Admin. Code Ann. R. 69L-22.011

Rulemaking Authority 440.491, 440.591 FS. Law Implemented 440.491 FS.

New 7-1-96, Amended 6-26-01, Formerly 38F-55.014, Amended 5-5-04, 5-7-09, Formerly 6A-22.011, Amended 3-31-14, Amended by Florida Register Volume 42, Number 081, April 26, 2016 effective 5/9/2016, Amended by Florida Register Volume 49, Number 163, August 22, 2023 effective 9/6/2023.

New 7-1-96, Amended 6-26-01, Formerly 38F-55.014, Amended 5-5-04, 5-7-09, Formerly 6A-22.011, Amended 3-31-14, 5-9-16, 9-6-23.