Nebraska Forms


 86 State Forms found

name number revision print or send online

First Report of Alleged Occupational Injury or Illness - EDI SUBMISSION

NWCC Form 1 Revised 12/2011

APPLICATION FOR AN ORDER APPROVING LUMP SUM SETTLEMENT

No Form Number No Form/Rev Date

SUBSEQUENT REPORT - EDI SUBMISSION

NWCC Form 4 Revised 06/2006

AGREEMENT FOR THE SELECTION OF A VOCATIONAL REHABILITATION COUNSELOR

VR-42C 7/23

Agricultural Operations & Workers' Compensation in Nebraska

No Form Number Revised July 2023

APPLICATION FOR CERTIFICATION

VR-39 Revised 07/2023

APPLICATION FOR RENEWAL OF CERTIFICATION

VR-39A Revised 07/2023

NOTICE OF EMPLOYEE'S RIGHT TO CHOOSE A DOCTOR (Spanish)

NWCC Form 50 (Spanish) Revised 04/2023

Choosing a Doctor for a Work-Related Injury - Rule 50

No Form Number Revised July 2023

Choosing a Doctor for a Work-Related Injury - Rule 50 (Spanish)

No Form Number Revisado en julio de 2023

FORMAL TRAINING - MILEAGE REIMBURSEMENT REQUEST (to report travel on and after 01/01/2018)

No Form Number 04/18

FORMAL TRAINING EMPLOYEE STUDENT INFORMATION AND INSTRUCTIONS

VR-44SI(A) Revised 07/2023

Independent Medical Examiner Application for Appointment

NWCC Form 62 03/2009

Informal Dispute Resolution & Mediation

No Form Number Revised July 2023

Informal Dispute Resolution & Mediation (Spanish)

No Form Number Revisado en julio de 2023
Disclaimer: These forms may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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