Florida Regulations 6A-22.011 - List of Forms
Florida Regulations > Department of Education > Division 6A > Chapter 6A-22 > § 6A-22.011. List of Forms
Current as of: Dec. 2011
(1) Forms DWC-21, Reemployment Services Billing Form; DWC-22, Reemployment Status Review Form; DWC-23, Request for Screening; DWC-24 Department and Student Agreement for Sponsorship of Training and Education; DWC-96, Qualified 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 and accompanying instructions are incorporated by reference as part of this rule to become effective with the effective date of this rule. Each form shall be typed or legibly completed in order for the form to be considered properly filed or submitted with the Department.
(a) The carrier shall submit the form DWC-21 to the Department.
(b) Reemployment status review form shall be submitted to the Department on form DWC-22.
(c) Request for screening form shall be submitted to the Department on form DWC-23.
(d) Department and student agreement for sponsorship of training and education form shall be completed on form DWC-24.
(e) Qualified rehabilitation provider application shall be submitted to the Department on form DWC-96.
(2) A copy of the forms and accompanying instructions incorporated by subsection 6A-22.011(1), F.A.C., may be obtained from the Department of Education, Bureau of Rehabilitation and Reemployment Services, 2728 Centerview Drive, Suite 101A, Forrest Building, Tallahassee, Florida 32399-0400. Copies are also available at the following Department web site: http://www.rehabworks.org/index.cfm?fuseaction=Submain.WorkersComp.
Rulemaking Authority 440.491(5), (6), (7) FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F-55.014, Amended 5-5-04, 5-7-09.
Laws implemented by this Rule: Florida Statutes § 440.491
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