Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Application - Spanish |
Print |
Angela Fujan | 10/20/2023 | |
Application - English |
Print Data Entry |
Angela Fujan | 10/20/2023 | Updated gender 10/20/23 Updated CAP phone number. 5/16/2023 Removed Sources & Services pages 4-30-2019 Updated with TBI stuff on 12-20-2021 |
Communication Assessment - English |
Print Data Entry |
Angela Fujan | 01/24/2023 | |
Job Planning Factors & Job Planning Discussion |
Order |
Angela Fujan | 10/26/2021 | |
IL Assessment-Barriers to Employment |
Print |
Carla Lasley | 07/31/2008 | |
IL Assessment-Household, Relocation, Cleaning |
Print |
Carla Lasley | ||
IL Assessment-Menu Planning/Prep, Laundry/Clothing Care, Daycare |
Print |
Carla Lasley | 07/31/2008 | |
IL Assessment-Rehab Engineering & Assistive Tech |
Print |
Carla Lasley | 07/31/2008 | |
IL Assessment-School Needs |
Print |
Carla Lasley | 07/31/2008 | |
IL Assessment-Transportation, Health & Hygiene |
Print |
Carla Lasley | 07/31/2008 | |
IL Assessment-Work-Site Needs/Accommodations |
Print |
Carla Lasley | 07/31/2008 | |
Physical Capacities |
Print Data Entry |
Angela Fujan | 02/28/2014 | |
Job Readiness Factors & Initial Meeting - A Guide for Staff |
Order |
Angela Fujan | 10/26/2021 | |
VR Psychological Narrative Report Guidelines |
Print |
Angela Fujan | 08/31/2006 | |
Functional Capacities Checklist |
Print Order Data Entry |
Angela Fujan | 04/10/2019 | |
Impairments Checklist |
Print Order |
Angela Fujan | 08/09/2019 | |
Nebraska VR ABI Interview | Data Entry | Keri Bennett | 05/24/2022 | |
Meet You Where You Are Model |
Print |
Mary Matusiak | 11/24/2020 | |
Meet You Where You Are-Brochure |
Order |
Mary Matusiak | 10/29/2015 | |
Career Planning Preferences - English |
Print Data Entry |
Angela Fujan | 01/01/2016 | |
(TWE) Trial Work Experience Agreement | Data Entry | Paige Rose | 02/23/2022 | |
Order of Selection (OOS) Questions & Answers |
Print |
Angela Fujan | 05/08/2018 | |
Information and Referral (I & R) to Other Programs |
Print Data Entry |
Paige Rose | 07/12/2022 | Used for CCIR appointments, and clients on the wait list during order of selection. I and R, I & R |
Guide for Approval of Eligibility and Priority Groups |
Print |
Angela Fujan | 11/30/2017 | |
Order of Selection (OOS) Fact Sheet |
Print |
Angela Fujan | 10/03/2022 | |
Order of Selection Communication to VR staff on process for working with DDD while all categories are closed |
Print |
Lindy Foley | 06/04/2018 | |
Order of Selection communication to VR staff on process for working with BH Regions while all categories are closed |
Print |
Lindy Foley | 06/04/2018 | |
Q & A on Employment Plans |
Print |
Carla Lasley | 06/19/2018 | Questions and answers are from a 6-19-18 Videoconference attended by VR staff. |
Template, Background, & Instructions for Completion of Employment Plan (I/DD) |
Print Data Entry |
Carla Lasley | ||
Template, Background, Instructions for BH Employment Plan |
Print |
Carla Lasley | 07/09/2018 | |
Order of Selection Update for BH SE Milestones |
Print |
Carla Lasley | 07/18/2018 | updated per DHHS |
VR Referral Form - English |
Print Data Entry |
Angela Fujan | 10/20/2023 | |
Key VR Time Frames |
Print |
Angela Fujan | 01/02/2019 | |
Signing of VR Documents chart |
Print |
Carla Lasley | 04/02/2019 | |
Initial Meeting Questions |
Print |
Angela Fujan | 08/01/2019 | |
Impediment Questions |
Print |
Angela Fujan | 04/04/2019 | |
Summary of Initial Meeting |
Print Data Entry |
Angela Fujan | 04/04/2019 | |
Summary of Initial Meeting-Spanish |
Print Data Entry |
Angela Fujan | 04/04/2019 | |
Information and Referral (I & R) to Other Programs - Spanish |
Print Data Entry |
Paige Rose | 07/12/2022 | I and R, I & R, |
Order of Selection Job Retention Questions |
Print Data Entry |
Angela Fujan | 03/31/2019 | |
Order of Selection (OOS) Fact Sheet Spanish |
Print |
Angela Fujan | 10/03/2022 | |
VR Process Chart | Angela Fujan | 10/26/2021 | ||
Initial Meeting to Next Step Guide |
Print |
Angela Fujan | 03/31/2021 | |
Clients Removed from Wait List Who are Working |
Print |
Paige Rose | 02/25/2020 | |
Client User ID Password Letter |
Print |
Cathy Callaway | 07/15/2021 | |
On-Line Access to Pay Stub |
Print |
Cathy Callaway | 07/15/2021 | |
On-line Access to Pay Stub-Spanish |
Print |
Cathy Callaway | 07/30/2021 | |
Career Planning Preferences - Spanish |
Print Data Entry |
Angela Fujan | 04/15/2020 | |
VR Referral Form - Spanish |
Print Data Entry |
Angela Fujan | 10/20/2023 | |
OOS Upgrading Priority Group Letter - English |
Print |
Angela Fujan | 08/04/2021 | |
AbilityOne Process | Data Entry | Paige Rose | 04/01/2022 | |
OOS Upgrading Priority Group Letter - Spanish |
Print |
Angela Fujan | 08/27/2021 | |
Progressive Employment Model | Mary Matusiak | 03/31/2022 | ||
Substance Use Disorders- VR Desk Reference |
Print |
Angela Fujan | 11/18/2022 | Rehabilitation Research and Training Center on Substance Abuse, Disability and Employment |
Communication Assessment - Spanish |
Print Data Entry |
Angela Fujan | 01/24/2023 | |
List of Background Checks | Carla Lasley | 01/05/2024 | ||
Functional Cognitive Assessment Referral | Data Entry | Keri Bennett | 03/01/2024 |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Action Planner |
Order |
Angela Fujan | 08/31/2011 | |
Appointment Reminder Postcard |
Order |
Sarah Chapin | 05/20/2014 | |
Assignment Purchases-Medicare |
Print |
Cathy Callaway | Must open this document in Excel | |
Assignment Purchases-Third Party |
Print |
Cathy Callaway | This document must be opened in Excel | |
Blank Memo Post Card |
Order |
Sarah Chapin | ||
Case File Order List |
Print |
Angela Fujan | 06/04/1919 | |
Client Reimbursement |
Print |
Cathy Callaway | 04/30/2019 | |
Acceptance Agreement Form (Equipment Agreement) |
Print Data Entry |
Mary Matusiak | 02/28/2021 | |
High Cost Request |
Print Data Entry |
Angela Fujan | 09/24/2019 | |
Next Steps - English |
Order |
Angela Fujan | 11/30/2010 | |
Proof of Purchase |
Print Data Entry |
Cathy Callaway | 04/30/2019 | |
Suicide Call |
Print Data Entry |
Holly Enriquez | 02/28/2009 | |
Provider Invoice |
Print Data Entry |
Cathy Callaway | 02/28/2013 | |
Next Steps- Spanish |
Print |
Angela Fujan | 11/30/2015 | |
Purchase of Goods and Services |
Print |
Angela Fujan | 05/01/2017 | |
Key VR Time Frames |
Print |
Angela Fujan | 01/02/2019 | |
Exit Status Decision Tree |
Print |
Paige Rose | ||
Electronic Case File Categories/Attachment Types | Cathy Callaway | 12/07/2022 | ||
A Guide for Supporting Individuals With Developmental Disabilities In The Workplace |
Print |
Cathy Callaway | 11/01/2010 | This was content saved from the old VRIS> |
Case File Request for Information |
Print Data Entry |
Cathy Callaway | 04/13/2023 | |
Medicaid Spreadsheet (No Insurance) | Data Entry | Amy Hancock | ||
Medicaid Spreadsheet (With Insurance) | Data Entry | Amy Hancock |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Direct Deposit Enrollment |
Print Data Entry |
Cinda Wacker | 07/31/2013 | |
Job Facts Guide |
Print Order |
Mary Matusiak | 05/31/2014 | Job Facts Guide is available as a fillable pdf. |
Job Search Agreement and Consent - English |
Print Order Data Entry |
Mary Matusiak | 03/16/2023 | |
Job Search Agreement and Consent - Spanish |
Print Data Entry |
Mary Matusiak | 03/16/2023 | |
Job Seeking Skills Training Application |
Print Data Entry |
Mary Matusiak | ||
Job Seeking Skills Training Booklet - English |
Order |
Mary Matusiak | 12/01/2017 | |
I-9 Checklist |
Print |
Holly Enriquez | ||
I-9 Form & Information |
Print |
Amy Hancock | 03/06/2024 | Amy Hancock provided this update on 10-31-23 |
W-4 Employee's Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 03/06/2024 | |
Weekly Job Search Record |
Print Order Data Entry |
Mary Matusiak | ||
Work Opportunity Tax Credits - 9061 Individual Characteristics - English |
Print |
Mary Matusiak | ||
Work Opportunity Tax Credits - 9061 Individual Characteristics - Spanish |
Print |
Mary Matusiak | ||
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request - English |
Print |
Mary Matusiak | ||
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request - Spanish |
Print |
Mary Matusiak | ||
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request Instructions |
Print |
Mary Matusiak | ||
On-the-Job Report |
Print Data Entry |
Paige Rose | 07/01/2020 | Replaces the OJT Training Progress Report and OJE Evaluation Report |
Volunteer/Non-Paid Accident Coverage | Holly Enriquez | 07/01/2022 | This form confirms that the State of Nebraska Vocational Rehabilitation has insurance in place for all registered volunteers and participants as outlined in the letter and signed by Pete Ricketts, Governor of the State of Nebraska. | |
Request for Certificate of Self-Insurance |
Print |
Holly Enriquez | 07/01/2023 | |
Focus Card Enrollment Form |
Print Data Entry |
Amy Hancock | 07/05/2023 | |
Request Temporary Access |
Print |
Holly Enriquez | 06/06/2022 | |
Time Conversion Chart |
Print |
Cathy Callaway | ||
W-4N Employee’s Nebraska Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 07/05/2023 | |
2024 OJE/TWE/WBLE Bi-weekly Payroll Schedule |
Print |
Melysa Johnson | 12/13/2023 | |
OJE/TWE Checklist |
Print Data Entry |
Paige Rose | 02/25/2022 | |
OJE/TWE Timesheet |
Print Data Entry |
Paige Rose | 01/12/2022 | |
OJE/TWE Consent |
Print Data Entry |
Paige Rose | 01/12/2022 | |
Optional Invoice for Providers WSST/Job Coaching 7/23 | Amy Hancock | 11/20/2023 | ||
Pearls of Placement Reference Guide | Mary Matusiak | 01/24/2024 |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Budget Worksheet-Post-Secondary |
Print |
Angela Fujan | 05/31/2006 | |
Budget Worksheet-Education Financial Aid |
Print |
Angela Fujan | 03/02/2016 | |
Financial Aid Budget Information |
Print |
Angela Fujan | 02/03/2011 | |
Post Secondary Training Justification - Word doc |
Print Data Entry |
Angela Fujan | 09/30/2010 | |
Post Secondary Training Justification - PDF |
Print Data Entry |
Angela Fujan | 09/30/2010 | |
Student Financial Aid Report (SFAR-E) |
Print Data Entry |
Angela Fujan | 04/30/2009 | |
VR Financial Aid | Data Entry | Angela Fujan | 11/10/2022 | |
Informational Interview Questionnaire | Data Entry | Paige Rose | 11/20/2018 |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
CPAP 2.0 Individualized Business Plan (IBP) |
Print Data Entry |
Mary Kunes-Neary | 08/16/2022 |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Self Employment Discussion Questionnaire-Data Entry |
Print Data Entry |
Julie Shively | 03/24/2021 | Use this Word version to allow for expanding data entry. Tab between fields. |
Self Employment Rates & Hourly Estimates |
Print |
Mary Matusiak | 05/25/2023 | |
Self Employment Personal Finance Worksheet |
Print Data Entry |
Julie Shively | 02/07/2017 | |
Self Employment-Advantages |
Print |
Julie Shively | 03/01/2017 | |
Self-Employment - Green Flags/Red Flags |
Print |
Julie Shively | 12/10/2021 | |
Self Employment Feasibility Referral Form |
Print Data Entry |
Julie Shively | 05/23/2022 | |
Self Employment Process Chart |
Print |
Julie Shively | 01/26/2018 | |
Supported Self-Employment Guidance |
Print |
Mary Matusiak | 05/23/2018 | |
Sources & Uses of Funds |
Print Data Entry |
Julie Shively | 04/09/2021 | |
Viability Referral | Data Entry | Angela Fujan | 06/14/2021 | Download form to open in Word. |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Volunteer/Unpaid Intern |
Print |
Holly Enriquez | This form is housed on Inside NDE. | |
Contracts, Letter Contracts, Purchasing Procedures | Cathy Callaway | |||
Direct Deposit Enrollment |
Print Data Entry |
Cinda Wacker | 07/31/2013 | |
Horizontal Wage Progression | Holly Enriquez | Contact NDE HR for this form. | ||
I-9 Checklist |
Print |
Holly Enriquez | ||
I-9 Form & Information |
Print |
Amy Hancock | 03/06/2024 | Amy Hancock provided this update on 10-31-23 |
Merit Stipend Request | Holly Enriquez | Contact NDE HR for this form | ||
Work Schedule |
Print |
Holly Enriquez | ||
SOS Personnel Request form (Will download to your Downloads folder) |
Print Data Entry |
Holly Enriquez | ||
Focus Card Enrollment Form |
Print Data Entry |
Amy Hancock | 07/05/2023 | |
ADA Guidance |
Print |
Holly Enriquez | 02/24/2017 | |
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request Instructions |
Print |
Mary Matusiak | ||
2024 OJE/TWE/WBLE Bi-weekly Payroll Schedule |
Print |
Melysa Johnson | 12/13/2023 |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
DHHS Registry Check |
Print |
Mary Matusiak | 03/15/2018 | VR Employees Only, Volunteers, Interns, Service Agreements |
Case Review Instrument - Employment Process |
Print |
Mary Matusiak | 05/02/2016 | |
Case Review Instrument - Vocational Evaluation |
Print |
Paige Rose | 12/07/2020 | Includes Case Review-Voc Eval instructions |
Case Review-Supported Employment (Milestones) |
Print Data Entry |
Carla Lasley | 04/10/2019 | |
Case Review Instrument-Compliance |
Print Data Entry |
Angela Fujan | 09/22/2020 | |
Confidentiality Agreement |
Print |
Holly Enriquez | 07/27/2021 | |
Incident/Accident/Injury Report for Clients & Applicants |
Print Data Entry |
Holly Enriquez | 02/08/2023 | |
Direct Purchase Authorization (DPA) |
Print Data Entry |
Cathy Callaway | ||
Employee Roster Information |
Print Data Entry |
Holly Enriquez | 05/03/2017 | |
Position Information Sheet Associate |
Print Data Entry |
Holly Enriquez | 10/25/2019 | |
Position Information Sheet Service/Rehab Specialists |
Print Data Entry |
Holly Enriquez | 10/25/2019 | |
Provider Program Review-Supported Employment |
Print Data Entry |
Carla Lasley | ||
Case Review Instrument Checklist-Quality Case Review |
Print Data Entry |
Angela Fujan | 09/21/2020 | |
Service Agreement | Data Entry | DJ Plautz | 01/08/2024 | |
Training Request |
Print Data Entry |
Ken Cuevas | 02/18/2020 | |
TSB Log |
Print |
Melysa Johnson | ||
Video & Media Information Release (Client) |
Print Data Entry |
Sarah Chapin | 04/30/2019 | |
Video Conference Participant List |
Print |
Paige Rose | 11/09/2018 | |
I-9 Checklist |
Print |
Holly Enriquez | ||
State Vehicle Waiver - VR English and Spanish |
Print |
Holly Enriquez | 06/04/2019 | English and Spanish waiver |
VR Vendor Office Listing |
Print |
Cathy Callaway | 12/31/2012 | |
Suicide Call Form |
Print Data Entry |
Holly Enriquez | 12/16/2015 | |
Code of Conduct |
Print Data Entry |
Angela Fujan | 02/01/2021 | |
Case Review Instrument- General |
Print Data Entry |
Angela Fujan | 06/08/2020 | referral to case closure |
Case Review Instrument- Task Notes |
Print Data Entry |
Angela Fujan | 09/22/2020 | |
Summary of Case Review Findings |
Print Data Entry |
Angela Fujan | 01/13/2020 | |
Transition Partnership Planning Form | Data Entry | Lupe Stevens | 08/17/2021 | Link to web form for the Transition Services Partnership Planner - Guide for Educators |
Case Review Instrument- Compliance Pre-Employment Transition Services |
Print Data Entry |
Lupe Stevens | 02/28/2021 | |
Training Plan | Data Entry | Ken Cuevas | 09/19/2018 | |
18/23 Month Assessment Action Plan |
Print Data Entry |
Holly Enriquez | 09/05/2018 | |
Order of Selection (OOS) Talking Points |
Print Data Entry |
Lindy Foley | 05/03/2018 | |
Case Review Instrument- Clerical Associate |
Print Data Entry |
Holly Enriquez | 07/18/2018 | |
Nebraska VR/SPED Inter-Departmental Agreement |
Print |
Lindy Foley | 08/22/2018 | Inter-departmental agreement between Nebraska VR and the Office of Special Education (SPED) |
NCBVI and Nebraska VR MOU |
Print |
Angela Fujan | ||
Continuity of Operations Plan (COOP) for COVID-19 |
Print |
Lindy Foley | 08/26/2021 | |
Nebraska VR Question and Answers Continuity of Operations Plan (COOP)- COVID 19 |
Print |
Lindy Foley | 04/01/2021 | |
Fax Log |
Print Data Entry |
Tibor Moldovan | 05/01/2020 | |
Case Review Instrument - DD Case Review | Data Entry | Paige Rose | 07/21/2021 | |
2024 OJE/TWE/WBLE Bi-weekly Payroll Schedule |
Print |
Melysa Johnson | 12/13/2023 | |
External Agency/Business Partner Media Release | Data Entry | Mary Matusiak | 03/16/2022 | |
Request Temporary Access |
Print |
Holly Enriquez | 06/06/2022 |
Form Name | Action | Form Owner | Revision Date | Notes |
---|---|---|---|---|
Voter Registration Form English |
Print Data Entry |
Holly Enriquez | 04/28/2021 | |
Tax Exempt Form (Form 13) |
Print |
Cathy Callaway | 06/30/2021 | Office Listing is included with the form |
W-4 Employee's Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 03/06/2024 | |
W-9 & ACH Enrollment |
Print Data Entry |
Cinda Wacker | ||
State Purchasing Bureau Non-CSI Justification Form |
Print Data Entry |
Cathy Callaway | 04/24/2017 | |
Voter Registration Form Spanish |
Print Data Entry |
Holly Enriquez | 04/28/2021 | |
W-4N Employee’s Nebraska Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 07/05/2023 | |
Voter Registration Disclaimer |
Print |
Holly Enriquez | 04/01/2020 | |
Voter Registration Disclaimer-Spanish |
Print |
Holly Enriquez | 04/14/2020 | |
Records Transfer Sheet |
Print |
Holly Enriquez | 04/06/2023 |