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, and to adopt DWC 252, Certificate of Election to be Exempt. 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.
SUBJECT AREA TO BE ADDRESSED: Revision of DWC 250, Notice of Election to be Exempt, its accompanying instructions, and updated addresses for the Division’s Bureau of Compliance field offices; the amendment also incorporates by reference Form DWC 252, Certificate of Election to be Exempt.
SPECIFIC AUTHORITY: 440.05, 440.591 FS.
LAW IMPLEMENTED: 440.05 FS.
A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Tuesday, August 28, 2007, 2:00 p.m.
PLACE: Room 104J, Hartman, 2012 Capital Circle S. E., Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Andrew Sabolic, Assistant Division Director, Division of Worker’s Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4229, (850)413-1600

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT 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.

(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 (352) 401-5350
Telephone (850) 798-5806

2012 Capital Circle, S. E.
Suite 102, Hartman Bldg.
Tallahassee, FL 32399-2161
Telephone (850) 413-1609

610 East Burgess Road	3111 South Dixie Highway
Pensacola, FL 32504-6320	Suite 123
Telephone (850) 453-7804	West Palm Beach, FL 33405
	Telephone (561) 837-5716

499 N.W. 70th Avenue	4415 Metro Parkway
Suite 116	Suite #300
Plantation, FL 33317	Ft. Myers, FL 33916
Telephone (954) 321-2906	Telephone (239) 938-1840

1313 North Tampa Street	1718 Main Street
Suite 503	Suite #201
Tampa, FL 33602	Sarasota, FL 34236
Telephone (813) 221-6506	Telephone (941) 361-6042

400 West Robinson Street	401 N.W. 2nd Avenue
Suite N 512, North Tower	South Tower, Suite 321
Orlando, FL 32801	Miami, FL 33128
Telephone (407) 835-4406	Telephone (305) 536-0306

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,________.