Florida Employee Notice for Reemployment Tax Coverage (Employer's Reciprocal Coverage Election) R.01/13

Employee Notice for Reemployment Tax Coverage (Employer's Reciprocal Coverage Election) R.01/13
Form RTS-6B
RTS-6B
R. 01/13
TC

Employee Notice
for Reemployment Tax* Coverage
(Employer’s Reciprocal Coverage Election)

	
Social
Employee’s Name: _______________________________________ Security No.:

Rule 73B-10.037
Florida Administrative Code
Effective Date 11/14

—

—

Residence Address: ______________________________________________________________________________________
City, State ZIP: ___________________________________________________________________________________________
Effective as of ___________________ 20_____, and until further notice, the Florida Reemployment Assistance Program
Law will be the law which applies to all work you perform for the undersigned employer, in any or all of the following
jurisdictions:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
This will be true under an election duly filed by the undersigned employer and approved by the state of Florida,
Department of Revenue, to which the other jurisdictions listed above duly consented.
If you become unemployed, you can file your reemployment assistance claim from any location in the state or
nation through the Internet at http://www.floridajobs.org/job-seekers-community-services. If you have
questions or need additional information concerning filing a claim for reemployment assistance benefits, you may
call 1-800-204-2418.
Save this notice in case it is needed, if and when you file a claim for benefits.
Firm-Name of Employer: ______________________________________________________________________________
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Employer’s Florida Reemployment Tax Account No.:
Date this notice is given or mailed to the employee:

M M

/D

D

/Y

Y Y Y

The employer must complete at least two copies of this notice, and distribute them as follows:
1.	 One copy must be delivered (or mailed) to the employee.
2.	 One copy must be sent to the:	
		
		

Florida Department of Revenue
PO Box 6510
Tallahassee FL 32314-6510

I understand and agree to the above statements.
_______________________________________________________________
(Signature of Employee)
*Formerly Unemployment Tax
Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the
administration of Florida’s taxes. SSNs obtained for tax administration purposes are confidential under sections 213.053
and 119.071, Florida Statutes, and not subject to disclosure as public records. Collection of your SSN is authorized
under state and federal law. Visit our Internet site at www.floridarevenue.com and select “Privacy Notice” for more
information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized
exceptions.
www.floridarevenue.com