(1) The following forms are hereby adopted and incorporated by reference. These forms shall be used to aid the Division in the performance of its administrative duties by securing pertinent facts and information on claims filed against the Fund, as the circumstances of particular cases may require.
    (a) DFS-D0-261, “Automobile Accident Report,” rev. 11/05;
    (b) DFS-D0-866, “Mileage Reimbursement,” rev. 11/05;
    (c) DFS-D0-1403, “General Liability Loss Report,” rev. 11/05;
    (d) DFS-D0-1404, “Lien Disclosure Statement,” rev. 11/05;
    (e) DFS-D0-1406, “Insurer’s Disclosure Statement Pursuant to Florida Statutes § 627.4137,” rev. 11/05;
    (f) DFS-D0-1407, “Medical Authorization,” rev. 2/10;
    (g) DFS-D0-1410, “Substitute Form W9″, new 11/05;
    (h) DFS-D0-1990, “Medicare Secondary Payer Reporting Questionnaire,” new 5/09; and,
    (i) DFS-D0-1991, “Medicare Beneficiary/Eligibility Information,” new 5/09.
    (2) Copies of each form adopted and incorporated by reference in this rule are available from the Division of Risk Management, Department of Financial Services, Larson Building, Tallahassee, Florida 32399-0336.
Rulemaking Authority 284.17, 284.39 FS. Law Implemented 284.30, 284.40, 284.41 FS. History—New 1-7-92, Amended 6-28-01, Formerly 4H-2.008, Amended 7-4-04, 5-4-05, 10-5-09, 1-9-11.