1. Ensure the individual is present in the state of Nebraska and available to actively participate in services.
2. Ensure Nebraska VR is the appropriate State VR agency.
   • Other State VR Agencies. If you learn a case is open with another state VR agency or if the individual tells you they are going to apply for services from another state VR agency, contact the Program Director for Counseling Services to discuss the situation and determine the appropriateness of opening a Nebraska VR case prior to completing the VR Application. Since both state VR programs offer the same services, there is a high likelihood for duplication of services. 
   • Nebraska Commission for the Blind and Visually Impaired (NCBVI). Nebraska VR cannot serve an individual whose ONLY disability is blindness or low vision. NCBVI is a state VR agency that specializes in serving individuals with vision impairments. If an individual is eligible for NCBVI, they need to work with that State VR agency. If the individual is not eligible for NCBVI AND has an additional impairment(s), VR may work with the individual and assess the primary impairment based on other disabling conditions. Impairments of vision can only be secondary or tertiary. If an individual presents with more than one disability, one of which is vision, prior to completing the VR Application refer the individual to NCBVI to determine if the visual impairment meets their eligibility criteria. 
     • If yes, NCBVI will serve the individual.
     • If no, conduct Initial Meeting.
     • Document in a TASK note - referral to and eligibility decision from NCBVI. If eligible for NCBVI, they must work with the agency who specializes in loss of vision, NCBVI.
     • If not eligible for NCBVI, determine if individual is eligible for Nebraska VR program based on non-visual impairment.
     • Nebraska VR staff can provide consultative services to a client of Nebraska Commission for the Blind and Visually Impaired (NCBVI) when the individual would benefit from the expertise of both programs. 
     • In rare cases an individual may have an active case with both state VR agencies (Nebraska VR and NCBVI) at the same time so long as the services provided by each are not duplicated and both VR agencies would be allowed to record a successful employment outcome. This would only occur if an existing or current Nebraska VR client’s vision becomes so severe it warrants consultation with NCBVI. NCBVI will then determine if the client is eligible and open a case or only provide consultation. 
3. Provide informed choice to apply. All prospective applicants shall be offered VR Orientation, Initial Meeting, and Information and Referral to other agencies to provide a clear understanding of VR services and the expectation to actively participate in services and to make an informed decision to apply for services. Nebraska VR staff are required to review the front and back of the VR Application with the applicant to ensure the understanding that Nebraska VR is an employment program and individuals who receive services must intend to work. Everyone has the right to apply, but if appropriate VR services are not available, address this and any other concerns with the referral, and as appropriate the authorized representative, to assist in identifying potential supports. Once an individual has completed the VR Application the assumption of benefit exists. Ineligibility determinations based on "cannot benefit from services" will only occur after the initial eligibility determination and an exploration of the individual's abilities, capabilities, and capacity to perform in realistic work situations. For further information see the Program Manual Chapters: Ineligibility, No Longer Eligible and Initial Meeting 
4. Required Forms: All individuals completing the VR Application are also required to complete a VR Release form. A case cannot proceed without both documents, as a signed release is needed to obtain medical information, coordinate services, contact employers, etc. In turn, the VR Release alone is not valid without the VR Application, as the release only pertains to VR applicants or recipients/clients of VR Services. All forms must be completed with appropriate signatures to apply for vocational rehabilitation services. Offer applicant a copy of documents completed. See Program Manual Chapter: Signature Requirements on VR Documents 
   • VR Application: Ensure the application is fully reviewed to allow the applicant and authorized representative, as applicable, to understand the information and provide informed choice to apply. The VR Application includes the Terms and Conditions on the back and the narrative section on the front, above the signature box where the applicant must attest all the information on the application is true, complete, and accurate, as well as their intent to work and lawful presence in the United States. When the application is fully completed with the appropriate signatures, it is then sufficient evidence of both, and no additional evidence is required. The VR Representative's signature is the final signature and effective date of the application. Prior to signing the form, VR must ensure all the questions have been answered and appropriate signatures were obtained. Note: Process for Emancipated Minor: For an individual under 19 years of age who is living separately (physically and financially) from parents and/or legally responsible adults, follow the procedure for obtaining a waiver of parent signature and completion of the Emancipated Minor Form. See the VR Application Form Process in this chapter for complete directions for VR Application completion. 
   • VR Release: Ensure appropriate signatures are gathered for a valid release. Discuss why the form is required and what information is shared. This form allows VR to gather medical information, obtain existing career planning information, coordinate services with other organizations, and exchange information with employers and other entities on the individual's behalf. 
   • Summary of Initial Meeting or Next Action: Complete either form, provide a written summary of the meeting and provide a copy to the applicant for reference to ensure the individual understands the next steps in the process. 
   • Information and Referral to Other Programs is required to be completed to identify appropriate resources with the local contact information, whether the referral applies for services or not.  
   • Other releases and screens, as applicable:
   • • SSDI or SSI recipient based on their disability: 
       • SSA 3288 Consent for Release of Information/General (VR) with appropriate signatures. See Program Manual Chapter: Eligibility Social Security Recipients
     • ABI (Acquired Brain Injury) pre-screening question: 
       • If the applicant answers “no” to this question on the application, no further action is needed.
       • If the applicant answers "yes" or "not sure", screen the applicant for their lifetime history of possible ABI incidents using the Nebraska VR ABI Interview Form at the time of application if time permits, or in a subsequent meeting. Document their answers in QE2 in the ABI Interview Forms section or on the fillable PDF or printed form for entry in QE2 later.
       • Discuss the results of the interview with the applicant, noting any challenges and the potential functional impact of their reported injuries, illnesses or events.
       • Obtain a signed release to request medical, psychological, or neuropsychological records that may confirm the reported injuries, illnesses or events and resulting impairments.
       • Download and give the applicant an age- and region-specific brochure listing ABI resources from the Brain Injury Advisory Council’s website at: https://braininjury.nebraska.gov/brain-injury-registry-brochures-2021 and ask if they would like assistance in connecting to services and supports in their community.
       • For guidance on additional assessment of cognitive impairment resulting from ABI, refer to the Nebraska VR Guide - Tools for Assessing Cognitive Function on VRIS under Guides & Resources, Job Planning Resource Guide. For additional help, contact the Program Director for ABI.
5. Complete QE2 data entry. Enter all the information from the completed Application form into QE2.
6. NOTE: Work documents can be verified any time prior to the IPE Approval to ensure lawful authorization to work. See Program Manual  Individualized Plan for Employment (IPE) for further information.
7. Note: Voter Registration. If the individual indicates they would like to register or re-register to vote follow the steps outlined in the Program Manual Chapter: Assisting Individuals with Disabilities to Register to Vote. 

Application Information:

Name and address: Legal name. Do not use diminutives or nicknames. If in doubt, use the name that appears on the person's Social Security card. For non-citizens, enter the name as it appears on his/her immigration document. An address must be gathered for the person, if they are homeless record the address of where they receive mail.

Hispanic or Latino: Self-reported ethnicity of the person. Persons who regard themselves as Hispanic or Latino should check "Yes." Hispanics or Latinos can be of any race. For example, many Hispanics coming to Nebraska from Mexico are Native American. Some coming from Puerto Rico, Cuba, the Dominican Republic, and other Caribbean nations are Black.

If refuse to answer, record as "No."

Race: This is the self-reported race of the person. They can check all boxes that apply. Multiple responses are permitted.

• White refers to people having origins in any of the original peoples of Europe, the Middle East, or North Africa. It includes people who describe their race or races as "White" or use other terms such as Irish, German, Italian, Lebanese, Near Easterner, Arab, or Polish.
• Black or African American refers to people having origins in any of the Black racial groups of Africa. It includes people who describe their race or races as "Black, African American, or Negro," or use other terms such as African American, Afro American, Nigerian, or Haitian.
• Asian refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. It includes people who describe their race or races as "Asian Indian," "Chinese," "Filipino," "Korean," "Japanese," "Vietnamese," or "Other Asian," or use other terms such as Burmese, Hmong, Pakistani, or Thai.
• Native American or Alaska Native refers to people having origins in any of the original peoples of North, Central, and South America, and who maintain tribal affiliation or community attachment. It includes people who describe their race or races using the terms "American Indian" or "Alaska Native" or by stating their principal or enrolled tribe, such as Santee Sioux, Chippewa, Omaha, or Inuit.
• Pacific Islander or Native Hawaiian refers to people having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. It includes people who describe their race or races as "Native Hawaiian," "Guamanian or Chamorro," "Samoan," or "Other Pacific Islander," or use other terms such as Tahitian, Mariana Islander, or Chuukese.
• "Refused" is an option for those who do not fit the above categories or do not wish to identify.

Lawful Presence: Self-identified on form.

Marital Status: Self-identified

Physical or mental impairments: Record the permanent medical conditions the person identifies as limiting their ability to work. Limitations include restrictions placed on the person's work activities by physicians and other health professionals. Identify the physical, mental, emotional and/or learning impairment(s) in sufficient detail to be able to identify the impairment and its cause in QE2. If there are several impairments to document, best practice would be to number them by the individual's identified severity of the impediment to employment, as this will assist you in determining the primary impairment for eligibility. 

Job wanted: Record the kind of job(s) the applicant states an interest in, regardless of whether this appears reasonable. If the applicant is unsure or has no job expectations, record that answer.

Help needed to go to work: Record the kind of help the applicant is requesting, regardless of whether this appears reasonable. If the individual is unsure or has no awareness of service needs, record that answer.

Medical/Health Insurance: Record the type of medical or health insurance the individual is covered by.

Veteran: Indicate if the individual served in the active military, naval or air service and was discharged or released under conditions other than dishonorable. 

Primary Source of Support: Mark the appropriate primary source of support for the applicant.

Cash benefits: These are benefits paid to the applicant because of their disability (Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)). Social security benefits received for reasons other than the individual's disability (retirement, widower's, etc.) would not be coded as SSDI or SSI in QE2. Also record any Veteran's Disability Benefits, Worker's Compensation benefit, TANF or other public support benefits they receive.

ABI pre-screening question: Identification of potential undiagnosed or “hidden” acquired brain injury (ABI) is important because long-term cognitive, physical, emotional, or behavioral results can present significant barriers to employment and community integration. The ABI pre-screening question on the application is the first step in identifying applicants with potentially undiagnosed ABI, and as appropriate, should be followed by an interview to obtain a lifetime history of possible incidents that may have resulted in ABI. 

If the Applicant is working at application, the employment information must be entered into the work history section of QE2. 

High School Students: If the person is in high school indicate if they have a 504 Plan or IEP.

Do you wish to register to vote? Nebraska VR must provide the opportunity to individuals with a disability to register to vote. Follow the steps outlined in the Program Manual Chapter: Assisting Individuals with Disabilities to Register to Vote.

Referral source: Record who told the individual to contact VR in sufficient detail to be able to accurately identify the Referral Source Category and Referral Source Name in QE2. Most people hear about VR or are told to go to VR by someone working for or associated with an organization. It may take some effort to clarify how the person heard about VR or from which organization they were referred.

Signatures:

• Applicant. The individual applying for services must sign the VR Application and Release forms. If the individual has difficulty signing their name a mark on the form is adequate, as this shows agreement and ownership in the process. 
• Authorized Representative. If the applicant has a legal authorized representative, the appropriate authorized representative must also sign the Application and Release. 
• VR Representative. Any VR staff member may sign the Application. The VR Representative receiving the completed application with the required signatures, shall acknowledge receipt by signing the application and dating the signature with the date and time the application was received. The VR representative signature is the final signature and effective date of the application.