Amendment AA10-SB70

SB70-AA10,639 Section 639. 343.16 (1) (a) 1. of the statutes is amended to read:

SB70-AA10,303,18 343.16 (1) (a) 1. Except as provided in subd. 5. and when examination by an authorized 3rd-party tester is permitted under pars. (b) to (c), the department shall examine every applicant for an operator's license, including applicants for license renewal as provided in sub. (3), and every applicant for authorization to operate a vehicle class or type for which the applicant does not hold currently valid authorization, other than an instruction permit.

SB70-AA10,640 Section 640. 343.16 (1) (a) 2. a. of the statutes is amended to read:

SB70-AA10,303,25 343.16 (1) (a) 2. a. Except as provided in par. (cm) and sub. (2) (cm) and (e), the examinations of applicants for licenses authorizing operation of “Class A", “Class B", “Class C", “Class D" or “Class M" vehicles shall include both a knowledge test and an actual demonstration in the form of a driving skills test of the applicant's ability to exercise ordinary and reasonable control in the operation of a representative vehicle.

SB70-AA10,641 Section 641. 343.16 (1) (a) 5. of the statutes is created to read:

SB70-AA10,304,3 343.16 (1) (a) 5. The department may waive the driving skills test of an individual applying for an operator's license if all of the following apply:

SB70-AA10,304,4 a. The applicant is under 18 years of age.

SB70-AA10,304,5 b. The application is for authorization to operate only “Class D" vehicles.

SB70-AA10,304,14 c. The applicant has satisfactorily completed a course in driver education in a public school approved by the department of public instruction, or in a technical college approved by the technical college system board, or in a nonpublic and private school or tribal school, as defined in s. 115.001 (15m), that meets the minimum standards set by the department of public instruction, or has satisfactorily completed a substantially equivalent course in driver training approved by the department and given by a school licensed by the department under s. 343.61, or has satisfactorily completed a substantially equivalent course in driver education or training approved by another state.

SB70-AA10,304,16 d. An adult sponsor who has signed for the applicant under s. 343.15 (1) consents to a waiver of the driving skills test.

SB70-AA10,642 Section 642. 343.16 (3) (a) of the statutes is amended to read:

SB70-AA10,305,8 343.16 (3) (a) Except as provided in s. 343.165 (4) (d), the department shall examine every applicant for the renewal of an operator's license once every 8 years. The department may institute a method of selecting the date of renewal so that such examination shall be required for each applicant for renewal of a license to gain a uniform rate of examinations. Subject to par. pars. (am) and (c), the examination shall consist of a test of eyesight. The department shall make provisions for giving such examinations at examining stations in each county to all applicants for an operator's license. The person to be examined shall appear at the examining station nearest the person's place of residence or at such time and place as the department designates in answer to an applicant's request. In lieu of examination, the applicant may present or mail to the department a report of examination of the applicant's eyesight by an ophthalmologist, optometrist or physician licensed to practice medicine. The report shall be based on an examination made not more than 3 months prior to the date it is submitted. The report shall be on a form furnished and in the form required by the department. The department shall decide whether, in each case, the eyesight reported is sufficient to meet the current eyesight standards.

SB70-AA10,643 Section 643. 343.16 (3) (c) of the statutes is created to read:

SB70-AA10,305,12 343.16 (3) (c) 1. An applicant for the renewal of an operator's license may apply for the license, and the department may issue the license, by any electronic means offered by the department if all of the following apply:

SB70-AA10,305,14 a. The applicant verifies that his or her eyesight is sufficient to meet the current eyesight standards.

SB70-AA10,305,16 b. The applicant satisfies any eligibility criteria established by the department under subd. 2.

SB70-AA10,305,18 2. The department may establish additional criteria for eligibility for license renewal by electronic means under this paragraph.

SB70-AA10,305,20 3. a. The department may renew a license under this paragraph without a test of eyesight.

SB70-AA10,305,23 b. Subject to s. 343.165 (7), the department may renew a license under this paragraph without a photograph being taken if the department is able to produce a photograph of the applicant from its records.

SB70-AA10,305,25 4. The department may not make consecutive renewals of an operator's license by electronic means.

SB70-AA10,644 Section 644. 343.305 (8) (b) 7. of the statutes is amended to read:

SB70-AA10,306,10 343.305 (8) (b) 7. The hearing examiner shall notify the person in writing of the hearing decision, of the right to judicial review and of the court's authority to issue a stay of the suspension under par. (c). If the person has requested electronic communication in the manner prescribed by the department, the hearing examiner may provide the notice under this subdivision by any electronic means offered by the department. The administrative suspension is vacated and the person's operating privilege shall be automatically reinstated under s. 343.39 if the hearing examiner fails to mail or provide this notice in the manner specified under this subdivision to the person within 30 days after the date of the notification under par. (a).

SB70-AA10,645 Section 645. 343.315 (4) of the statutes is amended to read:

SB70-AA10,306,19 343.315 (4) Notification and commencement. The Except as provided in this section, the department shall send the a notice of disqualification under this section by 1st class mail to a person's last-known residence address. If a person has requested electronic notification in the manner prescribed by the department, the department may provide the notice of disqualification by any electronic means offered by the department. A period of disqualification ordered under this section commences on the date on which the notice is sent under this subsection. This subsection does not apply to disqualifications under sub. (2) (g).

SB70-AA10,646 Section 646. 343.44 (3) of the statutes is amended to read:

SB70-AA10,307,8 343.44 (3) Failure to receive notice. Refusal to accept or failure to receive an order of revocation, suspension, or disqualification mailed by 1st class mail to such person's last-known address shall not be provided as authorized by the statutes is not a defense to the charge of driving after revocation, suspension , or disqualification. If the person has changed his or her address and fails to notify the department as required in s. 343.22 then failure to receive notice of revocation, suspension, or disqualification shall not be mailed as authorized by the statutes is not a defense to the charge of driving after revocation, suspension or disqualification. If a person has requested electronic notification in the manner prescribed by the department and the person has changed the electronic contact information provided to the department without informing the department, failure to receive notice of revocation, suspension, or disqualification is not a defense to the charge of driving after revocation, suspension, or disqualification.

SB70-AA10,647 Section 647. 344.02 (1) of the statutes is amended to read:

SB70-AA10,308,2 344.02 (1) Whenever the department under s. 344.13 gives notice of the amount of security required to be deposited and that an order of suspension or impoundment will be made if such the security is not deposited, it the department shall afford the person so notified subject to the proposed action an opportunity for a hearing on the proposed action, if written request for a hearing is received by the department prior to the date specified in the notice, or prior to the postponed effective date of suspension if postponement has been granted under s. 344.14 (1). Upon Except as provided under this section, upon receipt of timely request for hearing, the department shall fix the time and place of the hearing and give notice thereof of the time and place of the hearing to such the person by regular mail. If the person has requested electronic notification in the manner prescribed by the department, the department may provide the notice of the time and place of the hearing by any electronic means offered by the department. The scope of the hearing is limited to the matter set forth in s. 344.14 (2) (k) and, subject to s. 344.14 (2m), to whether or not the person is the owner of the motor vehicle to be impounded. Any person who fails without reasonable cause to appear at the time and place specified in the notice shall forfeit the right to a hearing.

SB70-AA10,648 Section 648. 344.13 (2) of the statutes is amended to read:

SB70-AA10,308,17 344.13 (2) The secretary shall determine the amount of security required to be deposited by each person on the basis of the accident reports or other information submitted. In addition to the accident reports required by law, the secretary may request from any of the persons, including passengers and pedestrians, involved in such accident such further information, sworn statements, or other evidence relating to property damage, personal injury, or death in motor vehicle accidents as deemed necessary to aid in determining the amount to be deposited as security under s. 344.14. Failure of a person to comply with such request is grounds for suspending such person's operating privilege but no suspension shall be made on such grounds until one follow-up request has been made and at least 20 days have elapsed since the mailing of providing the first request. The first request under this subsection shall be mailed to the person or, if the person has requested electronic communication in the manner prescribed by the department, may be provided by any electronic means offered by the department

SB70-AA10,649 Section 649. 351.025 (2) of the statutes is amended to read:

SB70-AA10,308,22 351.025 (2) The revocation is effective Revocation under this section takes effect on the date the department mails, if the notice is sent be 1st class mail, or provides, if the notice is by electronic means, the notice of revocation under s. 351.027 (1).

SB70-AA10,650 Section 650. 351.027 (1) of the statutes is amended to read:

SB70-AA10,309,6 351.027 (1) Whenever the secretary under authority of s. 351.025 revokes a person's operating privilege under s. 351.025, the secretary shall immediately notify the person in writing of the revocation and of the person's right to a hearing on the revocation as provided in sub. (2). The. Except as provided in this subsection, the department shall send the notice by 1st class mail to the address most recently provided to the department by the person. If a person has requested electronic notification in the manner prescribed by the department, the department may provide the notice by any electronic means offered by the department.” .

SB70-AA10,309,7 291. Page 374, line 11: after that line insert:

SB70-AA10,309,8 “ Section 651. 66.1011 (1) of the statutes is amended to read:

SB70-AA10,309,21 66.1011 (1) Declaration of policy. The right of all persons to have equal opportunities for housing regardless of their sex, race, color, disability, as defined in s. 106.50 (1m) (g), sexual orientation, as defined in s. 111.32 (13m), religion, national origin, marital status, family status, as defined in s. 106.50 (1m) (k), status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), status as a holder or nonholder of a license under s. 343.03 (3r), lawful source of income, age, or ancestry is a matter both of statewide concern under ss. 101.132 and 106.50 and also of local interest under this section and s. 66.0125. The enactment of ss. 101.132 and 106.50 by the legislature does not preempt the subject matter of equal opportunities in housing from consideration by political subdivisions, and does not exempt political subdivisions from their duty, nor deprive them of their right, to enact ordinances that prohibit discrimination in any type of housing solely on the basis of an individual being a member of a protected class.

SB70-AA10,652 Section 652. 66.1201 (2m) of the statutes is amended to read:

SB70-AA10,310,4 66.1201 (2m) Discrimination. Persons otherwise entitled to any right, benefit, facility, or privilege under ss. 66.1201 to 66.1211 may not be denied the right, benefit, facility, or privilege in any manner for any purpose nor be discriminated against because of sex, race, color, creed, national origin, sexual orientation, status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), or national origin status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,653 Section 653. 66.1213 (3) of the statutes is amended to read:

SB70-AA10,310,11 66.1213 (3) Discrimination. Persons otherwise entitled to any right, benefit, facility, or privilege under this section may not be denied the right, benefit, facility, or privilege in any manner for any purpose nor be discriminated against because of sex, race, color, creed, national origin, sexual orientation, status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), or national origin status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,654 Section 654. 66.1301 (2m) of the statutes is amended to read:

SB70-AA10,310,18 66.1301 (2m) Discrimination. Persons entitled to any right, benefit, facility, or privilege under ss. 66.1301 to 66.1329 may not be denied the right, benefit, facility, or privilege in any manner for any purpose nor be discriminated against because of sex, race, color, creed, national origin, sexual orientation, status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), or national origin status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,655 Section 655. 66.1333 (3) (e) 2. of the statutes is amended to read:

SB70-AA10,310,25 66.1333 (3) (e) 2. Persons otherwise entitled to any right, benefit, facility, or privilege under this section may not be denied the right, benefit, facility, or privilege in any manner for any purpose nor be discriminated against because of sex, race, color, creed, national origin, sexual orientation, status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), or national origin status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,656 Section 656. 86.195 (5) (c) of the statutes is amended to read:

SB70-AA10,311,8 86.195 (5) (c) Conformity with discrimination laws. Each business identified as a motorist service on a specific information sign shall, as a condition of eligibility for erection, installation and maintenance of a sign under this section, give written assurance to the department that the business conforms with all applicable laws concerning the provisions of public accommodations without regard to race, religion, color, sex or, national origin , or status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,657 Section 657. 106.50 (1) of the statutes is amended to read:

SB70-AA10,311,24 106.50 (1) Intent. It is the intent of this section to render unlawful discrimination in housing. It is the declared policy of this state that all persons shall have an equal opportunity for housing regardless of sex, race, color, sexual orientation, disability, religion, national origin, marital status, family status, status as a holder or nonholder of a license under s. 343.03 (3r), status as a victim of domestic abuse, sexual assault, or stalking, lawful source of income, age, or ancestry and it is the duty of the political subdivisions to assist in the orderly prevention or removal of all discrimination in housing through the powers granted under ss. 66.0125 and 66.1011. The legislature hereby extends the state law governing equal housing opportunities to cover single-family residences that are owner-occupied. The legislature finds that the sale and rental of single-family residences constitute a significant portion of the housing business in this state and should be regulated. This section shall be considered an exercise of the police powers of the state for the protection of the welfare, health, peace, dignity, and human rights of the people of this state.

SB70-AA10,658 Section 658. 106.50 (1m) (h) of the statutes is amended to read:

SB70-AA10,312,6 106.50 (1m) (h) “Discriminate" means to segregate, separate, exclude, or treat a person or class of persons unequally in a manner described in sub. (2), (2m), or (2r) because of sex, race, color, sexual orientation, disability, religion, national origin, marital status, family status, status as a holder or nonholder of a license under s. 343.03 (3r), status as a victim of domestic abuse, sexual assault, or stalking, lawful source of income, age, or ancestry.

SB70-AA10,659 Section 659. 106.50 (1m) (nm) of the statutes is amended to read:

SB70-AA10,312,12 106.50 (1m) (nm) “Member of a protected class" means a group of natural persons, or a natural person, who may be categorized because of sex, race, color, disability, sexual orientation, religion, national origin, marital status, family status, status as a holder or nonholder of a license under s. 343.03 (3r), status as a victim of domestic abuse, sexual abuse, or stalking, lawful source of income, age, or ancestry.

SB70-AA10,660 Section 660. 106.50 (5m) (f) 1. of the statutes is amended to read:

SB70-AA10,312,19 106.50 (5m) (f) 1. Nothing in this section prohibits an owner or agent from requiring that a person who seeks to buy or rent housing supply information concerning family status, and marital, financial, and business status but not concerning race, color, disability, sexual orientation, ancestry, national origin, religion, creed, status as a holder or nonholder of a license under s. 343.03 (3r), status as a victim of domestic abuse, sexual assault, or stalking, or, subject to subd. 2., age.

SB70-AA10,661 Section 661. 106.52 (3) (a) 1. of the statutes is amended to read:

SB70-AA10,312,25 106.52 (3) (a) 1. Deny to another or charge another a higher price than the regular rate for the full and equal enjoyment of any public place of accommodation or amusement because of sex, race, color, creed, disability, sexual orientation, national origin, or ancestry or because a person holds or does not hold a license under s. 343.03 (3r).

SB70-AA10,662 Section 662. 106.52 (3) (a) 2. of the statutes is amended to read:

SB70-AA10,313,5 106.52 (3) (a) 2. Give preferential treatment to some classes of persons in providing services or facilities in any public place of accommodation or amusement because of sex, race, color, creed, sexual orientation, national origin , or ancestry or because a person holds or does not hold a license under s. 343.03 (3r).

SB70-AA10,663 Section 663. 106.52 (3) (a) 3. of the statutes is amended to read:

SB70-AA10,313,13 106.52 (3) (a) 3. Directly or indirectly publish, circulate, display or mail any written communication which the communicator knows is to the effect that any of the facilities of any public place of accommodation or amusement will be denied to any person by reason of sex, race, color, creed, disability, sexual orientation, national origin, or ancestry or because a person holds or does not hold a license under s. 343.03 (3r) or that the patronage of a person is unwelcome, objectionable or unacceptable for any of those reasons.

SB70-AA10,664 Section 664. 106.52 (3) (a) 4. of the statutes is amended to read:

SB70-AA10,313,17 106.52 (3) (a) 4. Refuse to furnish or charge another a higher rate for any automobile insurance because of race, color, creed, disability, national origin, or ancestry or because a person holds or does not hold a license under s. 343.03 (3r).

SB70-AA10,665 Section 665. 106.52 (3) (a) 5. of the statutes is amended to read:

SB70-AA10,313,23 106.52 (3) (a) 5. Refuse to rent, charge a higher price than the regular rate or give preferential treatment, because of sex, race, color, creed, sexual orientation, national origin, or ancestry or because a person holds or does not hold a license under s. 343.03 (3r), regarding the use of any private facilities commonly rented to the public.

SB70-AA10,666 Section 666. 111.31 (1) of the statutes is amended to read:

SB70-AA10,314,16 111.31 (1) The legislature finds that the practice of unfair discrimination in employment against properly qualified individuals by reason of their age, race, creed, color, disability, marital status, sex, national origin, ancestry, sexual orientation, arrest record, conviction record, military service, use or nonuse of lawful products off the employer's premises during nonworking hours, or declining to attend a meeting or to participate in any communication about religious matters or political matters, substantially and adversely affects the general welfare of the state. Employers, labor organizations, employment agencies, and licensing agencies that deny employment opportunities and discriminate in employment against properly qualified individuals solely because of their age, race, creed, color, disability, marital status, sex, national origin, ancestry, sexual orientation, arrest record, conviction record, military service, status as a holder or nonholder of a license under s. 343.03 (3r), use or nonuse of lawful products off the employer's premises during nonworking hours, or declining to attend a meeting or to participate in any communication about religious matters or political matters, deprive those individuals of the earnings that are necessary to maintain a just and decent standard of living.

SB70-AA10,667 Section 667. 111.31 (2) of the statutes is amended to read:

SB70-AA10,315,5 111.31 (2) It is the intent of the legislature to protect by law the rights of all individuals to obtain gainful employment and to enjoy privileges free from employment discrimination because of age, race, creed, color, disability, marital status, sex, national origin, ancestry, sexual orientation, arrest record, conviction record, military service, status as a holder or nonholder of a license under s. 343.03 (3r), use or nonuse of lawful products off the employer's premises during nonworking hours, or declining to attend a meeting or to participate in any communication about religious matters or political matters, and to encourage the full, nondiscriminatory utilization of the productive resources of the state to the benefit of the state, the family, and all the people of the state. It is the intent of the legislature in promulgating this subchapter to encourage employers to evaluate an employee or applicant for employment based upon the individual qualifications of the employee or applicant rather than upon a particular class to which the individual may belong.

SB70-AA10,668 Section 668. 111.31 (3) of the statutes is amended to read:

SB70-AA10,315,17 111.31 (3) In the interpretation and application of this subchapter, and otherwise, it is declared to be the public policy of the state to encourage and foster to the fullest extent practicable the employment of all properly qualified individuals regardless of age, race, creed, color, disability, marital status, sex, national origin, ancestry, sexual orientation, arrest record, conviction record, military service, status as a holder or nonholder of a license under s. 343.03 (3r), use or nonuse of lawful products off the employer's premises during nonworking hours, or declining to attend a meeting or to participate in any communication about religious matters or political matters. Nothing in this subsection requires an affirmative action program to correct an imbalance in the work force. This subchapter shall be liberally construed for the accomplishment of this purpose.

SB70-AA10,669 Section 669. 111.321 of the statutes is amended to read:

SB70-AA10,316,2 111.321 Prohibited bases of discrimination. Subject to ss. 111.33 to 111.365, no employer, labor organization, employment agency, licensing agency, or other person may engage in any act of employment discrimination as specified in s. 111.322 against any individual on the basis of age, race, creed, color, disability, marital status, sex, national origin, ancestry, arrest record, conviction record, military service, status as a holder or nonholder of a license under s. 343.03 (3r), use or nonuse of lawful products off the employer's premises during nonworking hours, or declining to attend a meeting or to participate in any communication about religious matters or political matters.

SB70-AA10,670 Section 670. 194.025 of the statutes is amended to read:

SB70-AA10,316,7 194.025 Discrimination prohibited. No motor carrier may engage in any practice, act or omission which results in discrimination on the basis of race, creed, sex or, national origin, or status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,671 Section 671. 224.77 (1) (o) of the statutes is amended to read:

SB70-AA10,316,16 224.77 (1) (o) In the course of practice as a mortgage banker, mortgage loan originator, or mortgage broker, except in relation to housing designed to meet the needs of elderly individuals, treat a person unequally solely because of sex, race, color, handicap, sexual orientation, as defined in s. 111.32 (13m), religion, national origin, age, or ancestry, the person's lawful source of income, or the sex, marital status, status as a holder or nonholder of a license under s. 343.03 (3r), or status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), of the person maintaining a household.

SB70-AA10,672 Section 672. 230.01 (2) (b) of the statutes is amended to read:

SB70-AA10,316,24 230.01 (2) (b) It is the policy of this state to provide for equal employment opportunity by ensuring that all personnel actions including hire, tenure or term, and condition or privilege of employment be based on the ability to perform the duties and responsibilities assigned to the particular position without regard to age, race, creed or religion, color, disability, sex, national origin, ancestry, sexual orientation, or political affiliation, or status as a holder or nonholder of a license under s. 343.03 (3r).

SB70-AA10,673 Section 673. 230.18 of the statutes is amended to read:

SB70-AA10,317,11 230.18 Discrimination prohibited. No question in any form of application or in any evaluation used in the hiring process may be so framed as to elicit information concerning the partisan political or religious opinions or affiliations of any applicant nor may any inquiry be made concerning such opinions or affiliations and all disclosures thereof shall be discountenanced except that the director may evaluate the competence and impartiality of applicants for positions such as clinical chaplain in a state institutional program. No discriminations may be exercised in the recruitment, application, or hiring process against or in favor of any person because of the person's political or religious opinions or affiliations or because of age, sex, disability, race, color, sexual orientation, national origin, or ancestry, or status as a holder or nonholder of a license under s. 343.03 (3r) except as otherwise provided.

SB70-AA10,674 Section 674. 234.29 of the statutes is amended to read:

SB70-AA10,317,20 234.29 Equality of occupancy and employment. The authority shall require that occupancy of housing projects assisted under this chapter be open to all regardless of sex, race, religion, sexual orientation, status as a holder or nonholder of a license under s. 343.03 (3r), status as a victim of domestic abuse, sexual assault, or stalking, as defined in s. 106.50 (1m) (u), or creed, and that contractors and subcontractors engaged in the construction of economic development or housing projects, shall provide an equal opportunity for employment, without discrimination as to sex, race, religion, sexual orientation, or creed.

SB70-AA10,675 Section 675. 343.03 (3m) of the statutes is amended to read:

SB70-AA10,318,4 343.03 (3m) Noncitizen limited-term license. If the issuance of any license described under sub. (3) requires the license applicant to present any documentary proof specified in s. 343.14 (2) (es) 2. to 7. 1m. b. to g. or (im) 2m. b., the license shall display on the front side of the license, in addition to any legend or label described in sub. (3), a legend identifying the license as limited term or, if the license authorizes the operation of a commercial motor vehicle, as a nondomiciled license. This noncitizen limited-term license may not be renewed except as provided in s. 343.165 (4) (c). A nondomiciled license may not be issued to a resident of Canada or Mexico.

SB70-AA10,676 Section 676. 343.03 (3r) of the statutes is amended to read:

SB70-AA10,318,13 343.03 (3r) Real ID Noncompliant license. If any license described under sub. (3) is issued based upon the exception specified in s. 343.165 (7), the license shall, in addition to any legend or label described in sub. (3), be marked in a manner consistent with requirements under applicable federal law and regulations to indicate that the license is issued in accordance with P.L. 109-13, section 202 (d) (11), and is not intended to be accepted by any federal agency for federal identification or any other official purpose. Section 344.62 applies to a person operating a motor vehicle under the authorization of a license issued under this subsection.

SB70-AA10,677 Section 677. 343.14 (2) (br) of the statutes is renumbered 343.14 (2) (br) 1. and amended to read:

SB70-AA10,318,25 343.14 (2) (br) 1. If Except as provided in subd. 2., if the applicant does not have a social security number, a statement made or subscribed under oath or affirmation that the applicant does not have a social security number and is not eligible for a social security number. The statement shall provide the basis or reason that the applicant is not eligible for a social security number, as well as any information requested by the department that may be needed by the department for purposes of verification under s. 343.165 (1) (c). The form of the statement shall be prescribed by the department, with the assistance of the department of children and families. A license that is issued or renewed under s. 343.17 in reliance on a statement submitted under this paragraph subdivision is invalid if the statement is false.