Fla. Admin. Code Ann. R. 69L-6.009 - Forms and Instructions

Current through Reg. 47, No. 249; December 28, 2021

(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. 12/08); and instructions for same (Instructions for Completing Notice of Election to be Exempt, (eff. 12/08).
(b) DWC 250-R Revocation of Election to be Exempt, (eff. 12/08).
(c) DWC 251 Notice of Election of Coverage, (eff. 12/08).
(d) DWC 251-R Revocation of Election of Coverage, (eff. 12/08).
(e) DWC 252, Certificate of Election to be Exempt, (eff. 1/08).
(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.
(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 (352) 401-5350
Telephone (904) 798-5806
2012 Capital Circle, S. E. 3111 South Dixie Highway
Suite 106, Hartman Bldg. Suite 123
Tallahassee, FL 32399-2161 West Palm Beach, FL 33405
Telephone (850) 413-1609 Telephone (561) 837-5716
610 East Burgess Road 4415 Metro Parkway
Pensacola, FL 32504-6320 Suite #300
Telephone (850) 453-7804 Ft. Myers, FL 33916
Telephone (239) 938-1840
499 N.W. 70th Avenue Live Oak Business Center
Suite 116 5969 Cattlemen Lane
Plantation, FL 33317 Sarasota, FL 34232
Telephone (954) 321-2906 Telephone (941) 329-1120
1313 North Tampa Street 401 N.W. 2nd Avenue
Suite 503 South Tower, Suite 321
Tampa, FL 33602 Miami, FL 33128
Telephone (813) 221-6506 Telephone (305) 536-0306
400 West Robinson Street
Suite N 512, North Tower
Orlando, FL 32801
Telephone (407) 835-4406 or (407) 245-0896

Notes

Fla. Admin. Code Ann. R. 69L-6.009
Specific Authority 440.05(9), 440.591 FS. Law Implemented 440.05 FS.
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, 1-7-08, 12-31-08.

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.