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 19 State Forms found

name number revision print or send online

Agricultural Operations & Workers' Compensation in Nebraska

 No Form Number Revised July 2023

AFFIDAVIT OF INTERPRETER SELECTION

 No Form Number Revised February 2025

Supportive Services Employee Student Information and Instructions

 VR-44SI(C) Revised 07/2023

JOB PLACEMENT INFORMATION & INSTRUCTIONS

 VR-44SI(B) Revised 07/2023

United States Citizenship Attestation Form

 No Form Number No Form/Rev Date

United States Citizenship Attestation Form (Spanish)

 No Form Number No Form/Rev Date

Case Closure Report-No Plan Proposed - ONLINE SUBMISSION

 VR-37E1 6/16

Case Closure Report- Plan or Plans Proposed - ONLINE SUBMISSION

 VR-37E2 6/16

Plan Closure Report - ONLINE SUBMISSION

 VR-37E3 6/16

Follow-Up Employment Status Report - ONLINE SUBMISSION

 VR-37E4 2/2019

Schedule for Fees for Medical Services 2017

 No Form Number Effective January 1, 2017

Flowchart: Which Fee Schedule Applies? (Effective for services provided on and after January 1, 2019)

 No Form Number No Form/Rev Date

Annual Report 2018

 No Form Number July 1, 2017-June 30, 2018

Schedule of Fees for Medical Services 2022

 No Form Number January 1, 2022

Schedule of Fees for Medical Services 2023

 No Form Number January 1, 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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