The DBPR EL-4502 is a regulatory notification form for licensed employee leasing companies in Florida. State law requires this form whenever a client company relationship begins or ends. The form must be submitted within 30 days of the relationship change.
The completed form must reach three separate parties. These are the Division of Workers' Compensation, the Department of Revenue, and the company's workers' compensation insurance carrier. All three recipients must be notified, as required by Chapter 468.529(3) of the Florida Statutes.
Employee leasing companies take on payroll and HR responsibilities for workers assigned to client company worksites. This arrangement lets businesses outsource workforce management while the leasing company handles taxes, benefits, and compliance reporting. The form officially documents which client companies are part of this arrangement.
To complete the form, you need identifying details for both companies involved. This includes employer identification numbers (EIN), business names, mailing addresses, and primary contact names. You also need the exact date the client relationship started or ended, plus the number of employees covered under the arrangement.
Accurate record-keeping is a core requirement for any licensed employee leasing company in Florida. The Florida Department of Business and Professional Regulation (DBPR) oversees compliance for all companies in this sector. Failure to submit required notices on time can trigger compliance penalties or affect your company's license status.
When a client company relationship ends, notifying insurers and state agencies prevents coverage gaps. It also ensures the correct party bears workers' compensation liability after the termination date. Missing this step can create confusion in the event of a workplace injury claim.
Both the leasing company and the client should keep signed copies of the completed form. These records serve as proof of compliance during a DBPR review or audit. They also help resolve any disputes about when a relationship was officially established or terminated.
The document is a single-page form. Most companies can complete and submit it in about 15 minutes. Keeping copies of all submitted forms simplifies future filings when a new client relationship change occurs.
| Question | Answer |
|---|---|
| Form Name | Dbpr El 4502 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ftb 4502 form, fl dbpr 4502, va form 4502 printable version, dbpr el4502 |