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Form Dfs-F2-Dwc-3 - Florida Department Of Financial Services Division Of Workers Compensation Page 4

DWC-3 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.

Form Dfs-F2-Dwc-3 - Florida Department Of Financial Services Division Of Workers Compensation Page 4