Form DBPR CPA10 "Continuing Education Provider and Ethics Course Approval Application" - Florida

What Is Form DBPR CPA10?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR CPA10 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR CPA10 "Continuing Education Provider and Ethics Course Approval Application" - Florida

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State of Florida
Department of Business and Professional Regulation
Board of Accountancy
Continuing Education Provider and Ethics Course Approval Application
Form # DBPR CPA 10
IMPORTANT – Submit all items as indicated by the instructions below with your application to ensure faster
processing.
If you have any questions or need assistance in completing this application, please contact the Department of Business
and Professional Regulation, Customer Contact Center, at 850.487.1395.
APPLICATION FEES
Continuing Education Ethics Provider – New
(No Fee)
Continuing Education Ethics Provider – Renewal
(No fee)
Continuing Education Ethics Course – New
$250.00 fee
Continuing Education Ethics Course – Renewal
$250.00 fee
Make check payable to the Florida Department of Business and Professional Regulation.
Please mail your completed application, application fee and required documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Rd
Tallahassee, FL 32399
Eligibility Questions (Continuing Education Ethics Course Application)
Answer
Does your course include a review of Chapters 455 and 473, F.S., and the related
 Yes
 No
administrative rules?
Does your course qualify for four CPE credits?
 Yes
 No
1) General Requirements
a) To maintain provider and course status in good standing, providers must adhere to the requirements outlined in
s. 455.2178, F.S., and
Chapter
61H1-33, F.A.C.
b) Provider and course approval is valid for the biennium during which the application was received and approved.
th
The biennium for continuing education ethics providers and approved courses ends on June 30
of each odd-
numbered year. For instance, if your provider status or course is approved on January 1, 2017, it will expire on
June 30, 2017; if it was approved on July 1, 2017, it will expire on June 30, 2019.
2) Ethics CPE Provider Application Requirement
i) Provider Status: A continuing education ethics provider must be a:
(1) Regionally Accredited Educational Institution;
(2) Commercial Educator;
(3) Governmental Agency;
(4) State or National Certified Public Accounting Professional Association;
(5) Certified Public Accountant who has not been disciplined by the Board; OR
(6) Certified Public Accounting Firm.
3) Continuing Education Ethics Course Application Requirements
a) Have submitted an ethics provider application prior to submitting this application (if this is your initial submission)
b) Pay $250 non-refundable application fee
For more information regarding the requirements, please refer to Chapter 61H1, Florida Administrative Code and
Chapter 473, Florida Statutes. Links are located on the board’s website under
Statutes and
Rules.
DBPR CPA 10 Ethics Provider & Course
Eff. Date: June 2021
Incorporated by Rule: 61-35.003, F.A.C.
Page 1 of 3
State of Florida
Department of Business and Professional Regulation
Board of Accountancy
Continuing Education Provider and Ethics Course Approval Application
Form # DBPR CPA 10
IMPORTANT – Submit all items as indicated by the instructions below with your application to ensure faster
processing.
If you have any questions or need assistance in completing this application, please contact the Department of Business
and Professional Regulation, Customer Contact Center, at 850.487.1395.
APPLICATION FEES
Continuing Education Ethics Provider – New
(No Fee)
Continuing Education Ethics Provider – Renewal
(No fee)
Continuing Education Ethics Course – New
$250.00 fee
Continuing Education Ethics Course – Renewal
$250.00 fee
Make check payable to the Florida Department of Business and Professional Regulation.
Please mail your completed application, application fee and required documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Rd
Tallahassee, FL 32399
Eligibility Questions (Continuing Education Ethics Course Application)
Answer
Does your course include a review of Chapters 455 and 473, F.S., and the related
 Yes
 No
administrative rules?
Does your course qualify for four CPE credits?
 Yes
 No
1) General Requirements
a) To maintain provider and course status in good standing, providers must adhere to the requirements outlined in
s. 455.2178, F.S., and
Chapter
61H1-33, F.A.C.
b) Provider and course approval is valid for the biennium during which the application was received and approved.
th
The biennium for continuing education ethics providers and approved courses ends on June 30
of each odd-
numbered year. For instance, if your provider status or course is approved on January 1, 2017, it will expire on
June 30, 2017; if it was approved on July 1, 2017, it will expire on June 30, 2019.
2) Ethics CPE Provider Application Requirement
i) Provider Status: A continuing education ethics provider must be a:
(1) Regionally Accredited Educational Institution;
(2) Commercial Educator;
(3) Governmental Agency;
(4) State or National Certified Public Accounting Professional Association;
(5) Certified Public Accountant who has not been disciplined by the Board; OR
(6) Certified Public Accounting Firm.
3) Continuing Education Ethics Course Application Requirements
a) Have submitted an ethics provider application prior to submitting this application (if this is your initial submission)
b) Pay $250 non-refundable application fee
For more information regarding the requirements, please refer to Chapter 61H1, Florida Administrative Code and
Chapter 473, Florida Statutes. Links are located on the board’s website under
Statutes and
Rules.
DBPR CPA 10 Ethics Provider & Course
Eff. Date: June 2021
Incorporated by Rule: 61-35.003, F.A.C.
Page 2 of 3
State of Florida
Department of Business and Professional Regulation
Board of Accountancy
Continuing Education Provider and Ethics Course Approval Application
Form # DBPR CPA 10
APPLICATION TYPES
If you are not a current ethics provider, check boxes 1 and 3.
If you are a current ethics provider, and you are looking to add an additional course, check box 3.
If you are a current ethics provider, and you are looking to renew your approved course, check boxes 2 and 4.
Note: You will have to submit a separate application for each course that you would like approved.
Select all that apply:
 Continuing Education Ethics Provider – New
[0106/1030]
no fee
 Continuing Education Ethics Provider – Renewal
[0106/2020]
no fee
[0107/1030]
$250.00 fee
 Continuing Education Ethics Course – New
 Continuing Education Ethics Course – Renewal
[0107/2020]
$250.00 fee
APPLICANT INFORMATION
Fill out each section completely. Do not use any nicknames, aliases, or initials. Note: a social security number/FEIN is required.
Are you an approved continuing education provider with any board within the Department
of Business and Professional Regulation?
 Yes  No
If you answered “yes” to the above question, enter your current Provider Number (if applicable):
Last/Surname
First
Middle
Suffix
Company/Organization Name
Social Security Number* (if applying as individual)
Federal Employer ID Number (if applying as company/organization)
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
Authorized Representative (First, Last and Title)
PHYSICAL ADDRESS
Street Address
City
State
Zip Code (+4 Optional)
County (if in Florida)
Country
MAILING ADDRESS
If your mailing address is the same as your physical address, write, “Same as above” in the space provided for the street address.
Street Address
City
State
Zip Code (+4 Optional)
County (if in Florida)
Country
*
The disclosure of your social security number is mandatory on all professional and occupational license applications, is solicited by the authority
granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation pursuant to §§ 409.2577,
409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and licensees by a Title IV-D child support agency to
assure compliance with child support obligations. It is also required by § 559.79(1), Florida Statutes, for determining eligibility for licensure and
mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be used by the Department of Business and Professional Regulation to identify
licensees for tax administration purposes.
DBPR CPA 10 Ethics Provider & Course
Eff. Date: June 2021
Incorporated by Rule: 61-35.003, F.A.C.
Page 3 of 3
PROVIDER ELIGIBILITY STATUS
Select the option that best describes either you or your organization. If you are applying as a Certified Public Accountant or
Certified Public Accounting Firm, enter your license number in the space provided.
 Regionally Accredited Educational Institution
 Commercial Educator
 Governmental Agency
 State or national Certified Public Accounting Professional Association
 Certified Public Accountant
License Number:
 Certified Public Accounting Firm
License Number:
Applicants must submit the following additional materials:
 A description of the ethics course
 A description of your staffing capabilities
 All course materials, to include your final exam and answer key
 A list of anticipated locations and dates you plan to conduct the courses
 A complete course curriculum (table of contents)
 A description of how you will update the course in response to rule or law changes
 Documentation that ethics course instructors will notify the ethics course provider of any disciplinary action taken
against the instructor by the Board
Course Information
Course Name:
Contact Hours:
__________________________ Course Method:
 Live Study
 Self-Study
AFFIRMATION BY WRITTEN DECLARATION
Each applicant or authorized representative must sign and date the affirmation by written declaration.
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand
that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of
perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that
falsification of any material information on this application may result in criminal penalty or administrative
action, including a fine, suspension or revocation of the license.
Signature:
Date:
Print Name:
DBPR CPA 10 Ethics Provider & Course
Eff. Date: June 2021
Incorporated by Rule: 61-35.003, F.A.C.
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