NOTICE OF ELECTION TO BE EXEMPT

TERMS AND CONDITIONS: The Florida Department of Financial Services, Division of Workers' Compensation (Division) is committed to protecting your privacy. The Division maintains physical, electronic and procedural safeguards to ensure that your private personal information is safe and secure. These safeguards assist us in preventing unauthorized disclosure or access to secure information. The security of your personal information is our top priority. To protect your information, the Division utilizes 128 bit encryption and the website will automatically log off after 60 minutes of inactivity during any session. Only authorized employees of the Division have access to your information. Each of these employees is trained in the proper handling of personal and confidential data.

This online payment service allows you to submit payment for a Notice of Election to be Exempt. By accepting these terms and conditions and clicking on the "Pay Now" button, you authorize the Division to initiate an Automated Clearing House (ACH) or credit card debit to the payment account that you have provided. The Division will assess a $1.00 service fee for each online payment. Additionally, if for any reason a payment is returned, the Division will assess a $15.00 fee. The Division has 30 days from the date the Notice of Election to be Exempt is received to review and determine your eligibility to be Exempt.

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not include your email address on the Notice of Election to be Exempt application. Communications with this office, regardless of the form or means of transmission, are subject to disclosure under the terms of Florida's public records law.

If the Division determines that a refund is due for an ACH debit, your account will be credited after a minimum of 5 business days. If the bank account is no longer valid at the time of reimbursement, a physical check will be mailed to you at the address provided. If the Division determines that a refund is due for a credit card payment, your credit card account will be reimbursed after a minimum of 5 business days. If the credit card account is no longer valid at the time of reimbursement, a physical check will be mailed to you at the address provided. The Division will not refund the $1.00 convenience fee that is assessed for each online payment.

The Division will not be responsible for any loss you may incur as a result of someone else misusing your banking information with or without your permission. However, you could be held liable for losses incurred by the Division or another party due to someone else using your banking information. You may not use anyone else's account at any time without the permission of the account holder.

The Division reserves the right to change the terms and conditions of its online payment service. You are required to review these terms and conditions prior to submitting an online payment. By using the Division's online payment service, you agree to abide by these terms and conditions.

If you have any questions, please contact the Division's Customer Service Office at 850-413-1609, option 2, toll free @ 1-800-342-1741, option 3, or email at wc_exemption@myfloridacfo.com.

Terms and Conditions




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