Where your future begins
Where your future begins
Contact: Carla Lasley
Created: 05/06/2019
Date Emailed to Staff: 05/08/2019
Effective Date: 05/07/2019
Summary of Changes
1) All forms requiring signatures have been revised to include a signature line for "Authorized Representive," as defined in Rule 72 and outlined in the "Signatures Required on VR Documents" chapter.
2) Any reference to 'guardian' on forms has been changed to 'authorized representative,' as guardian is one type of authorized representative.
3) Any reference to 'consumer' has been changed to 'client' on any form that still contains the word 'consumer.' This is in response to an earlier decision to refer to a person served as a 'client.' One form, previously titled "Consumer Reimbursement Form" is now "Client Reimbursement Form." No other form titles were affected by this change.
Forms - New or Revised
The following forms were changed:
Acceptance Agreement Form (Equipment Agreement)
Application English and Spanish
ATP/VR Referral Form
Authorization to Exchange Information with Employer–Past Nebraska VR Client & CPAP
Client Reimbursement Form
Community Work Assessment
Consent for a Non-paid On-the-Job Evaluation or On-the-Job Training Placement-English and Spanish
Consent for a Paid On-the-Job Evaluation or On-the-Job Training Placement- English and Spanish
Corrective Action Plan
CPAP Application
CPAP Education Budget Worksheets
CPAP IPE Amendment/Job Goal
CPAP IPE Amendment/Termination of Services
CPAP Multi Agency Release
CPAP Referral
CPAP Release of Information
CPAP Request for Medical Information
Discovery Booklet IPE Job Goal/Supported Employment
Documentation Checklist Adult
Documentation Checklist Youth
Education Budget Worksheet
Independent Provider Packet
Individualized Plan for Employment (IPE) - Job Goal/Supported Employment-No carbon required (NCR) version
Individualized Plan for Employment (IPE) – Amendment of Job Goal at Outcome/Termination of service-No carbon required (NCR) version
Individualized Plan for Employment (IPE) – Job Goal/Supported Employment (Spanish)
Individualized Plan for Employment (IPE) – Amendment of Job Goal at Outcome/Termination of service (Spanish)
Job Search Agreement
Job Search Agreement Spanish
Mediation Referral
Milestone BH 1
Milestone BH 2
Milestone BH 3
Milestone BH 4
Milestone for I/DD 1
Milestone for I/DD 2
Milestone for I/DD 2 Customized
Milestone for I/DD 3
Milestone for I/DD 4
Milestone for I/DD ABI Autism 5A & B
Multi Agency Release
Pre ETS Consent for a Non-paid Work Based Learning Experience
Pre ETS Consent for a Non-paid Work Based Learning Experience Spanish
Pre ETS Consent for a Paid Work Based Learning Experience 14-15 year old workers
Pre ETS Consent for a Paid Work Based Learning Experience 14-15 year old workers Spanish
Pre ETS Consent for a Paid Work Based Learning Experience 16 and older workers
Pre ETS Consent for a Paid Work Based Learning Experience 16 and older workers Spanish
Pre ETS Refusal of Services (while in High School)
Pre-Employment Transition Services Consent & Information Release Spanish
Pre-Employment Transition Services Consent & Information Release
Proof of Purchase form
Refusal to participate (Adult)
Release of Information
Request for Medical Information
State Vehicle Waiver - VR
Video & Media Information Release
VR Profile
QE2 Update
No changes at this time; changes to reflect the use of the term 'authorized representative' in QE2 have been requested.
To Do
Remove any paper copies or saved to desktop copies of any of these forms and begin using the revised ones.
Team Communication
Reminder to seek new forms and ensure there is understanding of the use of the forms to secure the proper authorized representative signature.
VRIS Posting
Changes to forms is being completed in follow-up to training provided on 4/9/19 and 4/11/19. The training was recorded and is available for 30 days on VRIS and relates to circumstances where an 'authorized representative' may or must sign on behalf of an applicant or client.
Monitoring Requirements
Ensure use of proper forms and signing by authorized representative, as applicable--monitor/review when processing paperwork, completing quality checks, and when completing program reviews.
Training Dates
No further training is planned; this change is in follow-up to training provided as above.