Form DR-416B, Optometrist's Certification of Total and Permanent Disability, is the certificate a licensed Florida optometrist signs to state that a named person is totally and permanently disabled due to legal blindness, under Rule 12D-16.002 of the Florida Administrative Code. It is one of the forms used with Osceola County property tax exemption claims: a Florida resident applying for a total and permanent disability exemption presents it, or a letter from the U.S. Department of Veterans Affairs, to the county property appraiser on or before March 1 of each year. On FillingPDF you can fill out the form online and download or print the completed PDF; the Osceola County Property Appraiser publishes the original.
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What is DR-416B?
Form DR-416B, Optometrist's Certification of Total and Permanent Disability, is the Florida form on which a licensed optometrist certifies that a named person is totally and permanently disabled as of January 1 due to legal blindness.
The form is issued under Rule 12D-16.002 of the Florida Administrative Code, and the revision printed on it is R. 11/12, effective 11/12. The certifying professional must be an optometrist licensed under Chapter 463, Florida Statutes. The form records the optometrist's name, the name of the disabled person (with Mr., Mrs., Miss or Ms.), that person's Social Security number, the year of the January 1 date, the optometrist's signature and date, the optometrist's printed address, and the Florida Board of Optometry license number with its issue date. A second statement says the condition renders the person totally and permanently disabled, and that the statements are true, correct and complete to the best of the optometrist's knowledge and professional belief.
The certification printed on this form is for disability due to legal blindness. The notice on the form says the person applying for the total and permanent disability exemption presents either a copy of this form or a letter from the United States Department of Veterans Affairs or its predecessor to the county property appraiser. The Osceola County Property Appraiser publishes this copy of the form.
Who needs to file DR-416B?
Each Florida resident applying for a total and permanent disability exemption must present to the county property appraiser either a copy of Form DR-416B or a letter from the United States Department of Veterans Affairs or its predecessor. If you are legally blind and choose the form, you take it to your optometrist.
- The applicant: presents the completed form and supplies the Social Security number the form asks for.
- The optometrist: each form is to be completed by a licensed Florida optometrist. The optometrist signs, dates, prints an address and gives the Florida Board of Optometry license number and issue date.
- Applicants with a VA letter: the notice allows a letter from the U.S. Department of Veterans Affairs or its predecessor in place of this form.
The printed certification covers disability due to legal blindness only. The notice to taxpayer and optometrist also warns that anyone who knowingly and willfully gives false information to claim homestead exemption commits a misdemeanor of the first degree under Section 196.131(2), Florida Statutes.
When to file DR-416B
Present Form DR-416B, or the alternative letter from the U.S. Department of Veterans Affairs or its predecessor, to the county property appraiser on or before March 1 of each year. That is the deadline the notice printed on the form gives each Florida resident applying for a total and permanent disability exemption.
The certification is stated as of January 1, and the optometrist enters the year in the space after "as of January 1,". Because the optometrist must sign and date the form first, ask for the certification well before March 1. The form prints no separate processing time.
Documents you need
- A letter from the United States Department of Veterans Affairs or its predecessor, which may be presented to the county property appraiser instead of this form.
How to fill out DR-416B
Enter the optometrist's name
In the opening line, "I, ___, an optometrist licensed pursuant to Chapter 463, Florida Statutes," enter the optometrist's name.
Select title and enter patient's name
Mark Mr., Mrs., Miss or Ms., then enter the name of the totally and permanently disabled person.
Enter the Social Security number
Enter the disabled person's Social Security number. Disclosure is mandatory under sections 196.011(1) and 196.101(7), Florida Statutes, and it is used to verify taxpayer identity and exemption information.
Enter the year of the January 1 date
Write the year in the space after "is totally and permanently disabled as of January 1,". The printed text then states the cause as legal blindness.
Complete the professional belief statement
Mark the title again and enter the disabled person's name in the second statement, which says the condition renders the person totally and permanently disabled.
Sign and date the certification
The optometrist signs and dates on the line labeled Signature and Date, confirming the statements are true, correct and complete to the best of the optometrist's knowledge and professional belief.
Print the optometrist's address
Under Address: (print), enter the street, city, state and ZIP code.
Enter the license number and issue date
Enter the Florida Board of Optometry license number and the date on the "Issued on" line.
Review and download the completed PDF
Check every entry, including the signature, date and Social Security number, then download or print the completed PDF from FillingPDF and present it to the county property appraiser as described under How to submit.
How to submit DR-416B
Form DR-416B is presented to the county property appraiser. The form prints no mailing address, portal, fax number or appointment rule, and it names no other channel.
- County property appraiser: give a copy of the completed, signed form to the property appraiser on or before March 1 of each year. This copy is published by the Osceola County Property Appraiser at the official PDF link; contact that office for its address and delivery options.
- In place of this form: a letter from the United States Department of Veterans Affairs or its predecessor may be presented instead.
Before you present it, check that the optometrist has signed and dated the form and filled in the address, license number and issue date, and that the Social Security number is entered; disclosure of it is mandatory. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Presenting the form to the county property appraiser after March 1; the notice sets March 1 of each year as the date.
- Having someone other than a licensed Florida optometrist complete the certification; the form says each one is to be completed by a licensed Florida optometrist.
- Leaving the Social Security number blank, although the form says disclosure is mandatory.
- Omitting the year in the space after "as of January 1,".
- Leaving the Florida Board of Optometry license number or the "Issued on" date empty.
- Submitting the form without the optometrist's signature and date, or without the optometrist's printed address.
- Entering false information to claim an exemption; Section 196.131(2), Florida Statutes, makes it a first-degree misdemeanor.
- Forgetting to enter the disabled person's name in both places where the form asks for it.
Frequently asked questions
What is Form DR-416B?
Form DR-416B is the Optometrist's Certification of Total and Permanent Disability. A licensed Florida optometrist uses it to certify that a named person is totally and permanently disabled as of January 1 due to legal blindness. The printed revision is R. 11/12, under Rule 12D-16.002, Florida Administrative Code.
Is Form DR-416B required for an Osceola County property tax disability exemption?
A Florida resident applying for a total and permanent disability exemption must present to the county property appraiser either a copy of this form or a letter from the U.S. Department of Veterans Affairs or its predecessor. The Osceola County Property Appraiser publishes this copy.
When is Form DR-416B due?
On or before March 1 of each year. The notice printed on the form says each Florida resident applying for the total and permanent disability exemption must present the form, or a VA letter, to the county property appraiser by that date.
Who has to complete and sign Form DR-416B?
A licensed Florida optometrist. The form says each one is to be completed by a licensed Florida optometrist, who signs and dates it and gives a printed address, a Florida Board of Optometry license number and its issue date.
Does Form DR-416B cover disabilities other than blindness?
No. The certification printed on the form states the person is totally and permanently disabled due to legal blindness, and it has no space to name another condition.
Why does Form DR-416B ask for a Social Security number?
Disclosure is mandatory. Sections 196.011(1) and 196.101(7), Florida Statutes, require it, and the form says it is used to verify taxpayer identity information and homestead exemption information submitted to property appraisers.
What happens if false information is given on Form DR-416B?
Under Section 196.131(2), Florida Statutes, knowingly and willfully giving false information to claim homestead exemption is a misdemeanor of the first degree, punishable by up to 1 year in jail, a fine, or both. The form warns both the taxpayer and the optometrist.
Can I fill out Form DR-416B online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF does not submit it: you present the completed, signed form to the county property appraiser, and the optometrist must still sign it.
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