Attachment 5 "Request to Repeal a Policy Form" - Florida

What Is Attachment 5?

This is a legal form that was released by the Florida Department of Juvenile Justice - 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 March 1, 2017;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • 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 fillable version of Attachment 5 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Attachment 5
FDJJ-1000-5
Request to Repeal a Policy Form
Effective 03/2017
Instructions: Submit this form to request the repeal of a Florida Department of Juvenile Justice Policy. The
form should be submitted to the Policy Coordinator following review and approval from the General Counsel’s
Office, and notify the Executive Leadership Team. Please refer to FDJJ 1000 Policy Development and Review
for more information.
Policy Number
Policy Subject/Title
Originating Office
Executive Leadership Team Member
Authority (Florida Statute, F.A.C., etc.)
Related References
Policy Purpose
Offices Affected by the Policy
Proposed Action:
Repeal FDJJ Policy _______________________________________________________ (Number and Subject/Title)
Reason for Proposed Action:
____________________________________________________________________________________________
____________________________________________________________________________________________
Financial Impact:
____________________________________________________________________________________________
____________________________________________________________________________________________
Counsel? Yes ☐ No ☐
Reviewed and Approved by General
If yes, approved by: ______________________ Date*: _________________
Reviewed and Approved by the Executive Leadership Team? Yes ☐ No ☐
If yes, enter the
date*: _________________
Requestor’s Name: _______________________________
Requestor’s Telephone Number: ______________
Requestor’s Email: _________________________
Program Area/Office: Choose an item.
Request Date: ___________________________________
Reset/Clear Form
Print Form
Save As
Internal Use
Policy Coordinator:
Date Received:
Date Repealed:
Attachment 5
FDJJ-1000-5
Request to Repeal a Policy Form
Effective 03/2017
Instructions: Submit this form to request the repeal of a Florida Department of Juvenile Justice Policy. The
form should be submitted to the Policy Coordinator following review and approval from the General Counsel’s
Office, and notify the Executive Leadership Team. Please refer to FDJJ 1000 Policy Development and Review
for more information.
Policy Number
Policy Subject/Title
Originating Office
Executive Leadership Team Member
Authority (Florida Statute, F.A.C., etc.)
Related References
Policy Purpose
Offices Affected by the Policy
Proposed Action:
Repeal FDJJ Policy _______________________________________________________ (Number and Subject/Title)
Reason for Proposed Action:
____________________________________________________________________________________________
____________________________________________________________________________________________
Financial Impact:
____________________________________________________________________________________________
____________________________________________________________________________________________
Counsel? Yes ☐ No ☐
Reviewed and Approved by General
If yes, approved by: ______________________ Date*: _________________
Reviewed and Approved by the Executive Leadership Team? Yes ☐ No ☐
If yes, enter the
date*: _________________
Requestor’s Name: _______________________________
Requestor’s Telephone Number: ______________
Requestor’s Email: _________________________
Program Area/Office: Choose an item.
Request Date: ___________________________________
Reset/Clear Form
Print Form
Save As
Internal Use
Policy Coordinator:
Date Received:
Date Repealed: