Fla. Admin. Code R. 6A-18.047
Forms and instructions used by the Division of Blind Services, Department of Labor and Employment Security, in its dealings with the public are prescribed and listed below. These forms and instructions are hereby incorporated and made a part of this rule. A copy of any form may be obtained without cost upon request to the Division of Blind Services, Department of Labor and Employment Security, 2540 Executive Center Circle, West, Suite 203, Tallahassee, FL 32399-2950. When requesting a specific form, reference should be made to the form number and title.
DBS-001 (7/81) | Referral and Application for Services (Section 413.011, F.S.) | |
DBS-002 (7/81) | Application for Identification Card (Section 413.091, F.S.) | |
DBS-003 (7/81) | Physician's Report on Eye Condition (Section 413.011, F.S.) | |
DBS-004 (7/81) | General Medical Examination Report (Section 413.011, F.S.) | |
DBS-005 (7/81) | Case Summary For Medical Consultant (Section 413.011, F.S.) | |
DBS-006 (7/81) | Final Report on Result of Operation Sight Restoration or Prevention of Blindness (Section 413.011, F.S.) | |
DBS-007 (8/81) | Application for Services Based on Economic Need (Section 413.011, F.S.) | |
DBS-008 (7/81) | Referral to Rehabilitation Facility (Section 413.011, F.S.) | |
DBS-009 (7/81) | Dental Examination Report (Section 413.011, F.S.) | |
DBS-010 (7/81) | Referral to Eye Clinic (Section 413.011, F.S.) | |
DBS-011 (7/81) | Client Transportation (Section 413.011, F.S.) | |
DBS-016 (8/81) | Invoice for Glasses (Section 413.011, F.S.) | |
DBS-017 (11/81) | Consent for Release of Information (Section 413.011, F.S.) | |
DBS-022 (4/82) | Facility Expenditure Report (Section 413.011, F.S.) | |
DBS-023 (4/82) | Facility Utilization Report (Section 413.011, F.S.) | |
DBS-100 (12/81) | Authorization and Billing Invoice (Client Services Vocational Rehabilitation Program) (Section 413.011, F.S.) | |
DBS-101 (7/81) | Individualized Written Rehabilitation Program (Section 413.011, F.S.) | |
DBS-101a (7/81) | Individualized Written Rehabilitation Program - Service Agreement (Section 413.011, F.S.) | |
DBS-103 (5/82) | Referral for Vocational Rehabilitation (Section 413.011, F.S.) | |
DBS-104 (7/81) | Client Service Log (Section 413.011, F.S.) | |
DBS-106 (12/81) | Training Progress Report (Section 413.011, F.S.) | |
DBS-107 (7/81) | Maintenance Invoice (Section 413.011, F.S.) | |
DBS-108 (8/82) | Client Equipment Receipt & Inventory Record (Section 413.011, F.S.) | |
DBS-200 (12/81) | Authorization and Billing Invoice (Client Services Medical and Social Services Program) (Section 413.011, F.S.) | |
DBS-201 (7/81) | Medical and Social Services Rehabilitation Plan (Section 413.011, F.S.) | |
DBS-203 (7/81) | Application for Preschool Program (Section 413.011, F.S.) | |
DBS-210 (7/81) | Title XX - Right to Appeal (Section 413.011, F.S.) | |
DBS-501 (3/83) | Notice of Appointment (Section 413.011, F.S.) | |
DBS-502 (3/83) | Certification of Legal Blindness Notice (Section 413.011, F.S.) | |
DBS-503 (3/83) | Notice of Missed Appointment (Section 413.011, F.S.) | |
DBS-701 (10/81) | Monthly Supervision Report (Section 413.051, F.S.) | |
DBS-703 (10/81) | Employee Personal Data (Section 413.051, F.S.) | |
DBS-704 (10/81) | Drivers License (Turn-in) Form (Section 413.011, F.S.) | |
DBS-706 (10/81) | Statement of Written Guidelines (Section 413.051, F.S.) | |
DBS-710 (10/81) | Petty Cash Receipt (Section 413.051, F.S.) |
Fla. Admin. Code Ann. R. 6A-18.047
Rulemaking Authority 20.05(1), 20.15(7), 120.53(1)(b), 229.053(1), 413.011(1)(m) FS. Law Implemented 20.05(1), 20.15(7), 120.53(1)(b), 413.011, 413.051, 413.091 FS.
New 6-28-83, Formerly 6A-18.15, 6A-18.015, 38K-1.015.