RT-28G
                                                                                                                 R. 12/15
                                                                                                                       TC
                                                                                                                 Rule  73B-10.037
                                                                                                  Florida Administrative Code
                                                                                                        Effective Date 12/15
                              Election of Public Employer Method of Payment                                      Page 1
                              Under the Florida Reemployment Tax* Law

Legal Entity:

Street Address:
                                                                                                  
                                                                         Reemployment Tax Account Number
City, State ZIP:

As a public employer defined in section (s.) 443.036(35), Florida Statutes (F.S.), we hereby elect the option checked below 
as our method of paying for the reemployment assistance benefits paid to our former employees.  

The method is to be effective 0 1     – 0 1   –    
                              M  M      D D     Y             Y

  1.  Reimbursable Method

               (a)  As a newly liable employer we elect the reimbursable method of payment for reemployment assistance 
                benefits.

               (b)  As an already liable employer we elect to change from the tax rate method to the reimbursable method of 
                payment for reemployment assistance benefits.

  2.  Tax Rate Method

               (a)  As a newly liable employer we elect the tax rate method of payment for reemployment assistance benefits 
                at the initial tax rate for a public employer.

               (b)  As an already liable employer we elect to change from the reimbursable method of payment for 
                reemployment assistance benefits to the tax rate method. 

                 Read the information on page two of this form carefully
                              before selecting a method of payment.

* Formerly Unemployment Tax

                                          www.floridarevenue.com
                                                850-488-6800

                                                                                                                      RT-28G
                                                                                                                      R. 12/15
                                                                                                                      Page 2

A public employer electing the tax rate method will be assigned the initial rate of .0025 for the first year under this method.  
After the first year, you will be assigned a rate based on your own experience rate record and the adjustment factors defined 
in s. 443.1313(4)(b), F.S.  The tax rate may vary from .0010 to .0540 and is on your gross wages. The taxable wage base cap 
described in s. 443.1217(2)(a), F.S., does not apply.

A public employer changing from the reimbursable method to the tax rate method will be required to pay under both methods 
until wages paid under the reimbursable method are out of the base period of claims.  Invoices for reimbursement will be due, 
if there are charges, as well as tax payments for the quarterly report.

Each of the options is for a mandatory period of two calendar years. Written application to terminate one method and change 
to another must be received at least 30 days prior to January 1 of the year for which the election is to be effective.

Under both payment methods, an Employer’s Quarterly Report (RT-6, formerly UCT-6) must be filed within 30 days following the 
end of each calendar quarter.  Any report not filed or filed late will be assessed a $25.00 penalty for each 30 days, or fraction 
thereof, that the report is delinquent, in addition to any other penalties that may be applicable.

Payment of tax is required with the RT-6 for the tax rate method of payment.  Failure to pay timely will result in an interest 
charge.

Payment of amount due under the reimbursable method is required within 30 days of the date mailed, shown on the Quarterly 
Reimbursement Invoice (RT-29, formerly UCT-29).

Signature:
                                                                                 –                     –    
                                                                         M  M      D              D      Y  Y
Title:
                                                                            –                          –       
                                                                         Telephone Number

          Have you checked the payment option on the front of this form?
          For this form to be valid, the effective date for method of payment
                               and your signature must be included.

Mail completed form to:

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

                                               www.floridarevenue.com
                                                     850-488-6800