Form RTS-6A "Employer's Reciprocal Coverage Election Supplemental Attachment" - Florida

What Is Form RTS-6A?

This is a legal form that was released by the Florida Department of Revenue - 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 January 1, 2013;
  • The latest edition provided by the Florida Department of Revenue;
  • 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 RTS-6A by clicking the link below or browse more documents and templates provided by the Florida Department of Revenue.

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Download Form RTS-6A "Employer's Reciprocal Coverage Election Supplemental Attachment" - Florida

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RTS-6A
Employer’s Reciprocal Coverage Election
R. 01/13
TC
Supplemental Attachment
Rule 73B-10.037
Florida Administrative Code
Effective Date 11/14
This form must be attached to each copy of the Employer’s Reciprocal Coverage Election (RTS-6).
1. The jurisdictions listed below are hereby included in Item 1 of the election to which this sheet is attached:
State
% Of Service
State
% Of Service
2. The employees listed below are hereby included in Item 2 of the election to which this sheet is attached:
Basis for Election in Florida
Social Security
Employee’s Legal
a) Does some work in Florida
Employee’s Name
Number
Residence
b) Residence in Florida
c) Related to a place of business in Florida
____________________________
_________________________________________________________________
Date
Firm – Name of Employer
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
RTS-6A
Employer’s Reciprocal Coverage Election
R. 01/13
TC
Supplemental Attachment
Rule 73B-10.037
Florida Administrative Code
Effective Date 11/14
This form must be attached to each copy of the Employer’s Reciprocal Coverage Election (RTS-6).
1. The jurisdictions listed below are hereby included in Item 1 of the election to which this sheet is attached:
State
% Of Service
State
% Of Service
2. The employees listed below are hereby included in Item 2 of the election to which this sheet is attached:
Basis for Election in Florida
Social Security
Employee’s Legal
a) Does some work in Florida
Employee’s Name
Number
Residence
b) Residence in Florida
c) Related to a place of business in Florida
____________________________
_________________________________________________________________
Date
Firm – Name of Employer
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