(1) Form DFS-F7-DWC-2133, Carrier and Self-Insurance Fund Quarterly Premium Report, Premium Documentation Spreadsheet, Carrier Profile and Instructions (Eff. 2/2014), is hereby incorporated by reference and required for use by all carriers and self-insurance funds for quarterly reporting to the Department of Financial Services, Division of Workers’ Compensation (Division) of assessments owed to the Workers’ Compensation Administration Trust Fund (WCATF) and Special Disability Trust Fund (SDTF) and payment of those assessments to the Division pursuant to subsections 440.49(9) and 440.51(1)-(5), F.S.
    (2) The Division will provide Form DFS-F7-DWC-2133 or its electronic equivalent to all active carriers and self-insurance funds authorized to write the workers’ compensation line of insurance in Florida that are known to it not later than five (5) days prior to the expiration of each calendar quarter. All carriers and self-insurance funds required to pay assessments to the WCATF and SDTF must return accurately completed Form DFS-F7-DWC-2133 to the Division, in accordance with instructions included in the form, and pay all assessments to the WCATF and SDTF that are due not later than thirty (30) days from the end of the calendar quarter for which the form applies. No carrier or self-insurance fund required to report assessment information to the Division and pay assessments to the WCATF and SDTF is excused from those obligations because it did not receive Form DFS-F7-DWC-2133 from the Division. Form DFS-F7-DWC-2133 can be obtained by contacting the following email address: Assessments.Unit@MyFloridaCFO.com or https://www.flrules.org/Gateway/reference.asp?No=Ref-04178.
Rulemaking Authority 440.49(9)(b)1., 440.51(2), (6), 440.591 FS. Law Implemented 440.49(9), 440.50, 440.51(1)-(5) FS. History—New 6-22-14.