Section 69L-5.221 - Safety Program Premium Credit(1) In order for self-insurers to receive up to a two percent (2%) credit on the computation of premiums used in the determination of the assessments for the Workers' Compensation Administration Trust Fund, the Special Disability Trust Fund and the Florida Self-Insurers Guaranty Association, Inc., they must state that they have established a workplace safety program in accordance with Section 440.1025, F.S.(2) The statement must be completed using Form DFS-F2-SI-9 (Self-Insurer Certification of Workplace Safety Program Premium Credit) effective 08/09, as incorporated by reference, and shall be filed annually sixty (60) days prior to their Anniversary Rating Date. Copies of this form are available at the Division of Workers' Compensation, Bureau of Monitoring and Audit, Self-Insurance Section, 1579 Summit Lake Drive, Tallahassee, FL 32317. The completed Form DFS-F2-SI-9 (Self-Insurer Certification of Employer Workplace Safety Program Premium Credit) effective 08/09, shall be mailed to the: Department of Financial Services
Division of Workers' Compensation
Assessments Unit
1579 Summit Lake Drive
Tallahassee, FL 32317
(3) Certifications not received prior to the Anniversary Rating Date shall be applied pro rata as of the date the certification is received at the Division.Fla. Admin. Code Ann. R. 69L-5.221
Rulemaking Authority 440.1025, 440.38(1), (2), (3), 440.385(6), 440.591 FS. Law Implemented 440.1025, 440.38(1), (2), (3), 440.385(1), (3), (6) FS.