Florida Administrative Code › 6 - DEPARTMENT OF EDUCATION › 6A - State Board of Education › Chapter 6A-18 - DIVISION OF BLIND SERVICES › Section 6A-18.047 - Forms and Instructions

Current through Reg. 50, No. 138; July 16, 2024
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.)
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.