FL Division of Workers' Compensation

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  Aggregate Claims Administration Change Report

  FLWC49 $69.00
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  Aggregate Defense Attorney Fee Report

  FLWC51 $69.00
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  Authorization & Request for Unemployment Compensation Information

  FLWC30 $69.00
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  Claim Cost Report

  FLWC13 $89.00
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  Employee Earnings Report

  FLWC19 $69.00
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  First Report of Injury or Illness

  FLWC1 $89.00
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  Individualized Written Re-Employment Plan

  FLWC20 $89.00
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  Maximum Medical Improvement/Permanent Impairment Determination Certification

  FLWC9A $89.00
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  Monthly Risk Class/SIC Code Report

  FLWC48 $69.00
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  Notice of Action/Change

  FLWC4 $69.00
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  Notice of Denial

  FLWC12 $69.00
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  Notification of Initial Treatment

  FLWC8 $69.00
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  Payment Schedules A, B, C, D, E

  FLWCPAYSCH $89.00
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  Permanent Total Off-Set Worksheets

  FLWC33 $89.00
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  Permanent Total Supplemental Worksheet

  FLWC35 $89.00
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  Proof of Claim

  FLWCSDF1 $69.00