Where your future begins
Where your future begins
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Application - Spanish |
Print |
Angela Fujan | 2024-07-01 | Show | |
| Application - English |
Print Data Entry |
Angela Fujan | 2024-07-01 | Updated per Angela 11/19/2024 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 | Show |
| Communication Assessment - English |
Print Data Entry |
Angela Fujan | 2023-01-24 | Show | |
| Job Planning Factors & Job Planning Discussion |
Order |
Angela Fujan | 2021-10-26 | Show | |
| Physical Capacities |
Print Data Entry |
Angela Fujan | 2014-02-28 | Show | |
| Job Readiness Factors & Initial Meeting - A Guide for Staff |
Order |
Angela Fujan | 2021-10-26 | Show | |
| VR Psychological Narrative Report Guidelines |
Print |
Angela Fujan | 2006-08-31 | Show | |
| Functional Capacities Checklist |
Print Order Data Entry |
Angela Fujan | 2019-04-10 | Show | |
| Impairments Checklist |
Print Order |
Angela Fujan | 2019-08-09 | Show | |
| Nebraska VR ABI Interview | Data Entry | Keri Bennett | 2026-05-11 | Show | |
| Career Planning Preferences - English |
Print Data Entry |
Angela Fujan | 2016-01-01 | Show | |
| (TWE) Trial Work Experience Plan | Data Entry | Kristi Berst | 2025-06-05 | Show | |
| Order of Selection (OOS) Questions & Answers |
Print |
Angela Fujan | 2018-05-08 | Show | |
| Information and Referral (I & R) to Other Programs |
Print Data Entry |
Angela Fujan | 2022-07-12 | Used for CCIR appointments, and clients on the wait list during order of selection. I and R, I & R | Show |
| Guide for Approval of Eligibility and Priority Groups |
Print |
Angela Fujan | 2017-11-30 | Show | |
| Order of Selection (OOS) Fact Sheet |
Print |
Angela Fujan | 2022-10-03 | Show | |
| Order of Selection Communication to VR staff on process for working with DDD while all categories are closed |
Print |
Lindy Foley | 2018-06-04 | Show | |
| Order of Selection communication to VR staff on process for working with BH Regions while all categories are closed |
Print |
Lindy Foley | 2018-06-04 | Show | |
| VR Referral Form - English |
Print Data Entry |
Angela Fujan | 2023-10-20 | Show | |
| Key VR Timeframes |
Print |
Angela Fujan | 2025-08-21 | Show | |
| Signing of VR Documents chart |
Print |
Carla Lasley | 2019-04-02 | Show | |
| Initial Meeting Questions |
Print |
Angela Fujan | 2019-08-01 | Show | |
| Impediment Questions |
Print |
Angela Fujan | 2023-05-04 | Show | |
| Summary of Initial Meeting |
Print Data Entry |
Angela Fujan | 2019-04-04 | Show | |
| Summary of Initial Meeting-Spanish |
Print Data Entry |
Angela Fujan | 2019-04-04 | Show | |
| Information and Referral (I & R) to Other Programs - Spanish |
Print Data Entry |
Angela Fujan | 2022-07-12 | I and R, I & R, | Show |
| Order of Selection Job Retention Questions |
Print Data Entry |
Angela Fujan | 2019-03-31 | Show | |
| Order of Selection (OOS) Fact Sheet Spanish |
Print |
Angela Fujan | 2022-10-03 | Show | |
| VR Process Chart | Angela Fujan | 2021-10-26 | Show | ||
| Initial Meeting to Next Step Guide |
Print |
Angela Fujan | 2021-03-31 | Show | |
| Client User ID Password Letter |
Print |
Cathy Callaway | 2021-07-15 | Show | |
| On-Line Access to Pay Stub - English |
Print |
Cathy Callaway | 2026-01-07 | Approved by Kaylee Huenink | Show |
| On-line Access to Pay Stub - Spanish |
Print |
Cathy Callaway | 2026-01-07 | Approved by Kaylee Huenink | Show |
| Career Planning Preferences - Spanish |
Print Data Entry |
Angela Fujan | 2020-04-15 | Show | |
| VR Referral Form - Spanish |
Print Data Entry |
Angela Fujan | 2023-10-20 | Show | |
| OOS Upgrading Priority Group Letter - English |
Print |
Angela Fujan | 2021-08-04 | Show | |
| AbilityOne Process | Data Entry | Kristi Berst | 2022-04-01 | Show | |
| OOS Upgrading Priority Group Letter - Spanish |
Print |
Angela Fujan | 2021-08-27 | Show | |
| Progressive Employment Model | Michael Enriquez | 2022-03-31 | Show | ||
| Substance Use Disorders- VR Desk Reference |
Print |
Angela Fujan | 2022-11-18 | Rehabilitation Research and Training Center on Substance Abuse, Disability and Employment | Show |
| Communication Assessment - Spanish |
Print Data Entry |
Angela Fujan | 2023-01-24 | Show | |
| List of Background Checks | Carla Lasley | 2024-01-05 | Show | ||
| Functional Cognitive Assessment Referral | Data Entry | Keri Bennett | 2026-01-29 | Show | |
| OJE Letter - Paid | Kristi Berst | 2025-06-05 | Show | ||
| OJE Letter - Unpaid | Kristi Berst | 2025-06-05 | Show | ||
| What to Expect During Nebraska VR ABI Interview |
Print |
Keri Bennett | 2025-11-24 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Action Planner |
Order |
Angela Fujan | 2011-08-31 | Show | |
| Assignment Purchases-Medicare |
Print |
Cathy Callaway | Must open this document in Excel | Show | |
| Assignment Purchases-Third Party |
Print |
Cathy Callaway | This document must be opened in Excel | Show | |
| Case File Order List |
Print |
Angela Fujan | 2019-06-04 | Show | |
| Client Reimbursement |
Print |
Cathy Callaway | 2019-04-30 | Show | |
| Acceptance Agreement Form (Equipment Agreement) |
Print Data Entry |
Michael Enriquez | 2021-02-28 | Show | |
| High Cost Request |
Print Data Entry |
Angela Fujan | 2019-09-24 | Show | |
| Next Steps - English |
Order |
Angela Fujan | 2010-11-30 | Show | |
| Proof of Purchase |
Print Data Entry |
Cathy Callaway | 2019-04-30 | Show | |
| Suicide Call |
Print Data Entry |
Holly Enriquez | 2009-02-28 | Show | |
| Provider Invoice |
Print Data Entry |
Cathy Callaway | 2026-02-26 | Show | |
| Next Steps- Spanish |
Print |
Angela Fujan | 2015-11-30 | Show | |
| Purchase of Goods and Services |
Print |
Angela Fujan | 2017-05-01 | Show | |
| Key VR Timeframes |
Print |
Angela Fujan | 2025-08-21 | Show | |
| Exit Status Decision Tree |
Print |
Kristi Berst | 2025-06-05 | Show | |
| Electronic Case File Categories/Attachment Types | Cathy Callaway | 2025-06-05 | Show | ||
| Case File Request for Information |
Print Data Entry |
Cathy Callaway | 2023-04-13 | Show | |
| Medicaid Spreadsheet (No Insurance) | Data Entry | Amy Hancock | Show | ||
| Medicaid Spreadsheet (With Insurance) | Data Entry | Cathy Callaway | 2025-03-31 | Show | |
| Case Review - Compliance (Draft) | Holly Enriquez | 2024-06-30 | Show | ||
| Case Review - Quality (Draft) | Holly Enriquez | 2024-06-30 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Direct Deposit Enrollment |
Print Data Entry |
Cinda Wacker | 2013-07-31 | Show | |
| Job Facts Guide |
Print Order |
Michael Enriquez | 2014-05-31 | Job Facts Guide is available as a fillable pdf. | Show |
| Job Search Agreement and Consent - English |
Print Order Data Entry |
Michael Enriquez | 2023-03-16 | Show | |
| Job Search Agreement and Consent - Spanish |
Print Data Entry |
Michael Enriquez | 2023-03-16 | Show | |
| Job Seeking Skills Training Application |
Print Data Entry |
Michael Enriquez | Show | ||
| Job Seeking Skills Training Booklet - English |
Order |
Michael Enriquez | 2017-12-01 | Show | |
| I-9 Checklist |
Print |
Holly Enriquez | Show | ||
| I-9 Form & Information |
Print |
Amy Hancock | 2024-03-06 | Amy Hancock provided this update on 10-31-23 | Show |
| W-4 Employee's Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 2026-01-07 | Show | |
| Weekly Job Search Record |
Print Order Data Entry |
Michael Enriquez | Show | ||
| Work Opportunity Tax Credits - 9061 Individual Characteristics - English |
Print |
Michael Enriquez | Show | ||
| Work Opportunity Tax Credits - 9061 Individual Characteristics - Spanish |
Print |
Michael Enriquez | Show | ||
| Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request - English |
Print |
Michael Enriquez | Show | ||
| Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request - Spanish |
Print |
Michael Enriquez | Show | ||
| Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request Instructions |
Print |
Michael Enriquez | Show | ||
| On-the-Job Report |
Print Data Entry |
Kristi Berst | 2025-06-30 | Replaces the OJT Training Progress Report and OJE Evaluation Report | Show |
| Volunteer/Non-Paid Accident Coverage | Holly Enriquez | 2025-07-07 | This form confirms that the State of Nebraska Vocational Rehabilitation has insurance in place for all registered volunteers and participants as outlined. | Show | |
| Request for Certificate of Self-Insurance | Holly Enriquez | 2025-07-01 | Show | ||
| Focus Card Enrollment Form |
Print Data Entry |
Amy Hancock | 2023-07-05 | Show | |
| Request Temporary Access |
Print |
Holly Enriquez | 2022-06-06 | Show | |
| Time Conversion Chart |
Print |
Cathy Callaway | Show | ||
| W-4N Employee’s Nebraska Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 2023-07-05 | Show | |
| 2026 OJE/TWE/WBLE Bi-weekly Payroll Schedule |
Print |
Melysa Johnson | 2025-12-16 | Show | |
| OJE/TWE Checklist |
Print Data Entry |
Kristi Berst | 2022-02-25 | Show | |
| OJE/TWE Timesheet |
Print Data Entry |
Kristi Berst | 2022-01-12 | Show | |
| OJE/TWE Consent |
Print Data Entry |
Kristi Berst | 2022-01-12 | Show | |
| Optional Invoice for Providers WSST/Job Coaching 7/23 | Amy Hancock | 2023-11-20 | Show | ||
| Pearls of Placement Reference Guide | Michael Enriquez | 2024-01-24 | Show | ||
| Employment Success Skills | Michael Enriquez | 2024-10-09 | Show | ||
| 2025 OJE/TWE/WBLE Bi-weekly Payroll Schedule | Melysa Johnson | 2024-12-11 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Budget Worksheet-Post-Secondary |
Print |
Angela Fujan | 2006-05-31 | Show | |
| Budget Worksheet-Education Financial Aid |
Print |
Angela Fujan | 2016-03-02 | Show | |
| Financial Aid Budget Information |
Print |
Angela Fujan | 2011-02-03 | Show | |
| Post Secondary Training Justification - Word doc |
Print Data Entry |
Angela Fujan | 2010-09-30 | Show | |
| Post Secondary Training Justification - PDF |
Print Data Entry |
Angela Fujan | 2010-09-30 | Show | |
| Student Financial Aid Report (SFAR-E) | Data Entry | Angela Fujan | 2024-08-14 | Show | |
| VR Financial Aid | Data Entry | Angela Fujan | 2022-11-10 | Show | |
| Informational Interview Questionnaire | Data Entry | Kristi Berst | 2018-11-20 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| CPAP 2.0 Individualized Business Plan (IBP) |
Print Data Entry |
Ami Stubben-Goetsch | 2022-08-16 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Section 511: Refusal of Pre-Employment Transition Services (While still in High School) | Data Entry | DJ Plautz | 2020-11-30 | Show | |
| Section 511: Refusal to Participate - English | Data Entry | DJ Plautz | 2023-01-27 | Show | |
| Section 511: Documentation Checklist for Adults (age 25 and older) | Data Entry | DJ Plautz | 2020-02-24 | Show | |
| Section 511: Documentation Checklist for Youth (Age 24 and younger) |
Print Data Entry |
DJ Plautz | 2020-02-24 | Show | |
| Information and Referral (I & R) to Other Programs |
Print Data Entry |
Angela Fujan | 2022-07-12 | Used for CCIR appointments, and clients on the wait list during order of selection. I and R, I & R | Show |
| Information and Referral (I & R) to Other Programs - Spanish |
Print Data Entry |
Angela Fujan | 2022-07-12 | I and R, I & R, | Show |
| Section 511: CCIR Case Review Checklist |
Print Data Entry |
DJ Plautz | 2023-01-24 | Show | |
| Section 511: Refusal to Participate - Spanish | Data Entry | DJ Plautz | 2023-01-27 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Self Employment Discussion Questionnaire-Data Entry |
Print Data Entry |
Julie Shively | 2021-03-24 | Use this Word version to allow for expanding data entry. Tab between fields. | Show |
| Self Employment Rates & Hourly Estimates |
Print |
Michael Enriquez | 2023-05-25 | Show | |
| Self Employment Personal Finance Worksheet |
Print Data Entry |
Julie Shively | 2017-02-07 | Show | |
| Self Employment-Advantages |
Print |
Julie Shively | 2017-03-01 | Show | |
| Self-Employment - Green Flags/Red Flags |
Print |
Julie Shively | 2021-12-10 | Show | |
| Self Employment Feasibility Referral Form |
Print Data Entry |
Julie Shively | 2022-05-23 | Show | |
| Self Employment Process Chart |
Print |
Julie Shively | 2018-01-26 | Show | |
| Supported Self-Employment Guidance |
Print |
Michael Enriquez | 2018-05-23 | Show | |
| Sources & Uses of Funds |
Print Data Entry |
Julie Shively | 2021-04-09 | Show | |
| Viability Referral | Data Entry | Angela Fujan | 2021-06-14 | Download form to open in Word. | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Volunteer/Unpaid Intern |
Print |
Holly Enriquez | This form is housed on Inside NDE. | Show | |
| Direct Deposit Enrollment |
Print Data Entry |
Cinda Wacker | 2013-07-31 | Show | |
| Horizontal Wage Progression | Holly Enriquez | Contact NDE HR for this form. | Show | ||
| I-9 Checklist |
Print |
Holly Enriquez | Show | ||
| I-9 Form & Information |
Print |
Amy Hancock | 2024-03-06 | Amy Hancock provided this update on 10-31-23 | Show |
| Merit Stipend Request | Holly Enriquez | Contact NDE HR for this form | Show | ||
| Work Schedule |
Print |
Holly Enriquez | Show | ||
| Focus Card Enrollment Form |
Print Data Entry |
Amy Hancock | 2023-07-05 | Show | |
| ADA Guidance |
Print |
Holly Enriquez | 2017-02-24 | Show | |
| Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request Instructions |
Print |
Michael Enriquez | Show | ||
| 2026 OJE/TWE/WBLE Bi-weekly Payroll Schedule |
Print |
Melysa Johnson | 2025-12-16 | Show | |
| 2025 OJE/TWE/WBLE Bi-weekly Payroll Schedule | Melysa Johnson | 2024-12-11 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Confidentiality Agreement |
Print |
Holly Enriquez | 2021-07-27 | Show | |
| Incident/Accident/Injury Report for Clients & Applicants |
Print Data Entry |
Holly Enriquez | 2023-02-08 | Show | |
| Direct Purchase Authorization (DPA) |
Print Data Entry |
Cathy Callaway | Show | ||
| Employee Roster Information |
Print Data Entry |
Holly Enriquez | 2017-05-03 | Show | |
| Position Information Sheet Associate |
Print Data Entry |
Holly Enriquez | 2019-10-25 | Show | |
| Position Information Sheet Service/Rehab Specialists |
Print Data Entry |
Holly Enriquez | 2019-10-25 | Show | |
| Supported Employment Case Review | DJ Plautz | 2024-07-01 | Show | ||
| Service Agreement | Data Entry | Carla Lasley | 0010-06-03 | Show | |
| Training Request |
Print Data Entry |
Ken Cuevas | 2020-02-18 | Show | |
| TSB Official Travel Log |
Print |
Melysa Johnson | 2026-01-01 | Added heading with printed Driver's first name. | Show |
| Video and Media Information Release for Clients |
Print Data Entry |
Sarah Chapin | 2025-04-29 | Release of Information, Media Release, Consent for Media | Show |
| I-9 Checklist |
Print |
Holly Enriquez | Show | ||
| State Vehicle Waiver - VR English and Spanish |
Print |
Holly Enriquez | 2019-06-04 | English and Spanish waiver | Show |
| Nebraska VR Office Listing |
Print |
Cathy Callaway | 2026-02-26 | Show | |
| Suicide Call Form |
Print Data Entry |
Holly Enriquez | 2015-12-16 | Show | |
| Code of Conduct |
Print Data Entry |
Angela Fujan | 2021-02-01 | Show | |
| Summary of Case Review Findings |
Print Data Entry |
Angela Fujan | 2020-01-13 | Show | |
| Transition Partnership Planning Form | Data Entry | Lupe Stevens | 2021-08-17 | Link to web form for the Transition Services Partnership Planner - Guide for Educators | Show |
| Training Plan | Data Entry | Ken Cuevas | 2018-09-19 | Show | |
| 18/23 Month Assessment Action Plan |
Print Data Entry |
Holly Enriquez | 2018-09-05 | Show | |
| Order of Selection (OOS) Talking Points |
Print Data Entry |
Lindy Foley | 2018-05-03 | Show | |
| Nebraska VR/SPED Inter-Departmental Agreement |
Print |
Lindy Foley | 2018-08-22 | Inter-departmental agreement between Nebraska VR and the Office of Special Education (SPED) | Show |
| Continuity of Operations Plan (COOP) for COVID-19 |
Print |
Lindy Foley | 2021-08-26 | Show | |
| Nebraska VR Question and Answers Continuity of Operations Plan (COOP)- COVID 19 |
Print |
Lindy Foley | 2021-04-01 | Show | |
| 2026 OJE/TWE/WBLE Bi-weekly Payroll Schedule |
Print |
Melysa Johnson | 2025-12-16 | Show | |
| External Agency/Business Partner Media Release | Data Entry | Michael Enriquez | 2022-03-16 | Show | |
| Request Temporary Access |
Print |
Holly Enriquez | 2022-06-06 | Show | |
| Compliance Review (Download Word Document) | Cathy Callaway | 2024-06-12 | Show | ||
| Quality Review (Download Word Document) | Cathy Callaway | 2024-06-12 | Show | ||
| 2025 OJE/TWE/WBLE Bi-weekly Payroll Schedule | Melysa Johnson | 2024-12-11 | Show |
| Form Name | Action | Form Owner | Revision Date | Notes | Associated Chapters |
|---|---|---|---|---|---|
| Voter Registration Form English |
Print Data Entry |
Holly Enriquez | 2025-12-22 | Show | |
| Tax Exempt Form (Form 13) |
Print |
Cathy Callaway | 2025-07-22 | Office Listing is included with the form | Show |
| W-4 Employee's Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 2026-01-07 | Show | |
| W-9 & ACH Enrollment |
Print Data Entry |
Cinda Wacker | Show | ||
| Exception Request-CSI Furniture (SPB Form 9) |
Print Data Entry |
Holly Enriquez | 2025-10-15 | Show | |
| Voter Registration Form Spanish |
Print Data Entry |
Holly Enriquez | 2025-12-22 | Show | |
| W-4N Employee’s Nebraska Withholding Allowance Certificate |
Print Data Entry |
Holly Enriquez | 2023-07-05 | Show | |
| Voter Registration Disclaimer |
Print |
Holly Enriquez | 2020-04-01 | Show | |
| Voter Registration Disclaimer-Spanish |
Print |
Holly Enriquez | 2020-04-14 | Show | |
| Records Transfer Sheet |
Print |
Holly Enriquez | 2023-04-06 | Show |