Employee Earnings Report - Florida Department Of Financial Services (Page 2 of 2) in pdf

Employee Earnings Report - Florida Department Of Financial Services Page 2

DWC-19 Purpose and Use Statement

The collection of the social security number on this form is imperative

for the Division of Workers' Compensation's performance of its duties

and responsibilities as prescribed by law. The social security number

will be used as a unique identifier in Division of Workers'

Compensation database systems for individuals who have claimed

benefits under Chapter 440, Florida Statutes. It will also be used to

identify information and documents in those database systems regarding

individuals who have claimed benefits under Chapter 440, Florida

Statutes, for internal agency tracking purposes and for purposes of

responding to both public records requests and subpoenas that require

production of specified documents. The social security number may also

be used for any other purpose specifically required or authorized by

state or federal law.

Employee Earnings Report - Florida Department Of Financial Services Page 2