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Case Services

Form Name Action Form Owner Revision Date Notes
Application/Sources & Services - Spanish Print
Angela Fujan 2017-10-31 Revised Spanish Application with Sources & Services page.
Application/Sources & Services - English Order
Data Entry
Angela Fujan 2017-10-31 Revised Application has addition of Sources & Services form
Communication Assessment Print
Data Entry
Angela Fujan 2016-08-31
Employment Discussion & Job Planning Discussion Guides Order
Janet Drudik 2016-05-04
IL Assessment-Barriers to Employment Print
Judy Vohland 2008-07-31
IL Assessment-Household, Relocation, Cleaning Print
Judy Vohland 2088-07-31
IL Assessment-Menu Planning/Prep, Laundry/Clothing Care, Daycare Print
Judy Vohland 2008-07-31
IL Assessment-Rehab Engineering & Assistive Tech Print
Judy Vohland 2008-07-31
IL Assessment-School Needs Print
Judy Vohland 2008-07-31
IL Assessment-Transportation, Health & Hygiene Print
Judy Vohland 2008-07-31
IL Assessment-Work-Site Needs/Accommodations Print
Judy Vohland 2008-07-31
Physical Capacities Print
Data Entry
Angela Fujan 2014-02-28
Planning & Readiness Factors Order
Jen Papproth 2018-01-23
Summary of Employment Discussion Print
Data Entry
Angela Fujan 2010-09-30
VR Psychological Narrative Report Guidelines Print
Angela Fujan 2006-08-31
Audiology Calculating Tool - Excel Data Entry Angela Fujan
Functional Capacities Checklist Print
Order
Angela Fujan 2017-12-21
Impairments Checklist Print
Order
Angela Fujan
Nebraska VR ABI Screen Print
Data Entry
Keri Bennett Replaces the HELPS TBI Screening Tool and HELPS Follow-up Questionnaire.
Nebraska Brain Injury Information, Referral and Resource Facilitation Services Brochure Print
Order
Keri Bennett 2017-03-01 Print or order through Nancy Noha at ATP
Meet You Where You Are-Options Print
Janet Drudik 2015-10-29
Meet You Where You Are-Brochure Order
Janet Drudik 2015-10-29
Career Planning Preferences Print
Data Entry
Paige Rose 2016-01-01
Nebraska Brain Injury Information, Referral and Resource Facilitation Services Brochure-Spanish Print
Order
Keri Bennett 2017-09-11 Spanish translation of the Nebraska Brain Injury Information, Referral and Resource Facilitation Services Brochure. Print or order through Nancy Noha at ATP
Section 511: VR Eligibility for DD Letter Print
Data Entry
Paige Rose 2017-07-18
Order of Selection (OOS) Questions & Answers Print
Lindy Foley 2018-05-08
OOS Retention Letter Print
Vicki Rasmussen 2017-11-20 Example of Retention letter sent out from State Office
OOS Off Waiting List Letter Print
Vicki Rasmussen 2017-12-08 Example of Off Wait List letter sent out by State Office
OOS Pre-Employment Transition Services Eligibility/Priority Group Letter (New Students) Print
Vicki Rasmussen 2018-07-11 Example of Order of Selection Pre-Employment Transition Services Eligibility/Priority Group Letter (New Students) sent out by State Office
Information and Referral (I & R) to Other Programs Print
Carla Lasley 2018-06-05 Used for CCIR appointments
Guide for Approval of Eligibility and Priority Groups Print
Angela Fujan 2017-11-30
OOS Fact Sheet Print
Order
Sarah Chapin 2018-05-02
Communication to VR staff on process for working with DDD while all categories are closed under Order of Selection Print
Lindy Foley 2018-06-04
Communication to VR staff on process for working with BH Regions while all categories are closed under OOS Print
Lindy Foley 2018-06-04
Q & A on Employment Plans Print
Lindy Foley 2018-06-19 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
OOS Adult Waiting List letter Vicki Rasmussen 2018-07-02 Example of Adult waiting list letter sent out by State Office
Template, Background, Instructions for BH Employment Plan Print
Carla Lasley 2018-07-09
OOS Update for BH SE Milestones 7-3-18 Print
Carla Lasley 2018-07-03 this is an update to the OOS memo dated 6-14-18
Form Name Action Form Owner Revision Date Notes
Action Planner Order
Angela Fujan 2011-08-31
Appointment Reminder Postcard Order
Sandy Ham 2014-05-20
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
Sandy Ham
Case File Order List Print
Angela Fujan 2013-10-29
Case Record Documentation Requirements Print
Angela Fujan 2011-10-31
Check Medicaid Rates Print
Cathy Callaway Must open this document in Excel
Consumer Reimbursement Print
Cathy Callaway
Equipment Agreement Print
Data Entry
Judy Vohland 2013-11-01
High Cost Approval Print
Data Entry
Angela Fujan 2013-10-31
Next Steps Order
Angela Fujan 2010-11-30
Proof of Purchase Print
Data Entry
Cathy Callaway 2014-06-02
Suicide Call Print
Data Entry
Vicki Rasmussen 2009-02-28
Termination Chart Print
Cheryl Ferree 2018-03-21
Provider Invoice Print
Data Entry
Cathy Callaway 2013-02-28
Check 3rd Party Medicaid Rates Print
Cathy Callaway Use with Excel
Next Steps- Spanish Print
Angela Fujan 2015-11-30
Purchase of goods and services Print
Angela Fujan 2017-05-01
Form Name Action Form Owner Revision Date Notes
Corrective Action Plan Print
Data Entry
Cathy Callaway 2011-02-28
Discovery Booklet Print
Order
Angela Fujan 2018-04-20
IPE Amendment of Job Goal at Outcome/Termination of Service - English Print
Order
Data Entry
Angela Fujan 2013-10-31
IPE Amendment of Job Goal at Outcome/Termination of Service - Spanish Print
Data Entry
Angela Fujan 2013-10-31
IPE Community Services - English Print
Order
Data Entry
Angela Fujan 2017-04-11
IPE Community Services - Spanish Print
Data Entry
Angela Fujan 2017-04-11
IPE Job Goal & IPE Supported Employment - English Print
Order
Data Entry
Angela Fujan 2017-04-11
IPE Job Goal & IPE Supported Employment - Spanish Print
Data Entry
Angela Fujan 2017-04-11
IPE Services to QE2 Crosswalk Print
Angela Fujan 2014-11-30 Legal Size
IPE Supports - English Print
Order
Data Entry
Angela Fujan 2016-01-30
IPE Supports - Spanish Print
Data Entry
Angela Fujan 2017-01-30
IPE - Important Information for You - English Print
Order
Angela Fujan 2015-07-31 The IPE-Important Information for You is the renamed and revised version of the IPE Terms
IPE VR Provided Services - English Print
Order
Data Entry
Angela Fujan 2017-03-14
IPE VR Provided Services - Spanish Print
Data Entry
Angela Fujan 2017-03-14
Make Sure this Job is Right for You Print
Order
Data Entry
Jen Papproth 2014-01-31
IPE - Important Information You Need to Know When Writing Your Own IPE - English Print
Order
Angela Fujan 2014-09-24 This document is only given to clients when choosing to write their own IPE without the assistance of a VR Specialist
IPE - Important Information for You - Spanish Print
Order
Angela Fujan 2017-05-24 The IPE-Important Information for You is the renamed and revised version of the IPE Terms. This is the Spanish version of the information.
IPE - Important Information You Need to Know When Writing Your Own IPE - Spanish Print
Order
Angela Fujan 2014-09-24 This document is only given to clients when choosing to write their own IPE without the assistance of a VR Specialist, Spanish version.
Form Name Action Form Owner Revision Date Notes
15 Day Letter Print
Angela Fujan 2014-06-02
Office Director Letter Print
Angela Fujan 2017-12-07
Successful closure - no benefits Print
Angela Fujan 2016-12-19
Termination Letter Print
Angela Fujan 2017-12-07
Constant Contact Welcome Letter with Link to Orientation Video Sarah Chapin 2017-12-13
Schedule A Certification Letter for VR Staff Print
Lindy Foley
Section 511: VR Eligibility for DD Letter Print
Data Entry
Paige Rose 2017-07-18
Orientation Welcome Letter-Word version Print
Sarah Chapin 2017-12-14
Successful closure - SS beneficiaries Print
Angela Fujan 2017-12-19
Successful closure - ID DD recipient Print
Angela Fujan 2018-02-09
CPAP Order of Selection letter 2&3 on the waiting list Print
Janet Drudik 2018-03-07
CPAP Order of Selection letter Priority group Print
Janet Drudik 2018-03-07
Form Name Action Form Owner Revision Date Notes
Direct Deposit Enrollment Print
Data Entry
Cinda Wacker 2013-07-31
Job Facts Guide Print
Order
Lindy Foley 2014-05-31 Job Facts Guide is available as a fillable pdf.
Job Search Agreement - English Print
Order
Data Entry
Lindy Foley 2013-01-31
Job Search Agreement - Spanish Print
Data Entry
Lindy Foley 2013-01-31
Job Seeking Skills Training Application Print
Data Entry
Lindy Foley
Job Seeking Skills Training Booklet - English Order
Lindy Foley 2017-12-01
I-9 Checklist Print
Vicki Rasmussen
I-9 Form & Information Print
Vicki Rasmussen
OJE/OJT Information Print
Data Entry
Cathy Callaway 2017-12-04
OJE/OJT Letter Checklist Print
Data Entry
Cathy Callaway
OJE/OJT Letters - OJE - Nonpaid Print
Paige Rose 2016-03-09
OJE/OJT Letters - OJE - State Print
Paige Rose 2016-03-09
OJE/OJT Letters - OJT - Nonpaid Print
Paige Rose 2018-05-08
OJE/OJT Letters - OJT - Private Print
Paige Rose 2018-05-08
OJE/OJT Letters - OJT - State Print
Paige Rose 2018-05-08
W4 Employee's Withholding Allowance Certificate Print
Vicki Rasmussen
Weekly Job Search Record Print
Order
Data Entry
Lindy Foley
Work Opportunity Tax Credits - 9061 Individual Characteristics - English Print
Lindy Foley
Work Opportunity Tax Credits - 9061 Individual Characteristics - Spanish Print
Lindy Foley
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request - English Print
Lindy Foley
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request - Spanish Print
Lindy Foley
Work Opportunity Tax Credits - 8850 - Pre-Screening Notice & Certification Request Instructions Print
Lindy Foley
On-the-Job Report Print
Data Entry
Paige Rose Replaces the OJT Training Progress Report and OJE Evaluation Report
Volunteer/Non-Paid Accident Coverage Vicki Rasmussen 2018-07-01 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 Janet Drudik 2015-03-29 Use URL to get Form so you always have the latest revision.
Request for Certificate of Self-Insurance Print
Vicki Rasmussen 2015-04-07 Use URL to get form The form is a link to the DAS site so you have the current form
FOCUS Card Enrollment Form (Replaces AccelaPay) Print
Data Entry
Cathy Callaway 2015-11-23
OJE/OJT Letters - OJE - Job Shadow Background Check Print
Data Entry
Jen Papproth 2016-07-21
Request Temporary Access Print
Vicki Rasmussen 2018-04-25
Community Work Assessment (CWA) Letter Checklist Data Entry Paige Rose 2017-02-28
Community Work Assessment (CWA) Consent Data Entry Paige Rose 2017-02-28
Community Work Assessment (CWA) Report Data Entry Paige Rose 2017-02-28
Bi-Weekly Schedule (2018) Information Print
Cathy Callaway 2017-12-07
2018 OJT Private Invoice Print
Data Entry
Cathy Callaway 2017-12-21
2018 OJE/OJT State Timesheet Print
Data Entry
Cathy Callaway 2017-12-21
2018 Community Work Assessment (CWA) Time Log Print
Data Entry
Paige Rose 2017-12-21
Income under WIOA Print
Data Entry
Paige Rose 2018-04-13
Form Name Action Form Owner Revision Date Notes
Budget Worksheet Print
Angela Fujan 2006-05-31
Education Budget Worksheet Print
Angela Fujan 2016-03-02
Financial Aid Budget Information Print
Angela Fujan 2011-02-03
Post Secondary Training Justification - Word doc Print
Data Entry
Angela Fujan 2010-09-30
Post Secondary Training Justification - PDF Print
Data Entry
Angela Fujan 2010-09-30
Student Financial Aid Report (SFAR-E) Print
Data Entry
Angela Fujan 2009-04-30
What You Should Know About VR Financial Aid Print
Angela Fujan 2010-08-31
Informational Interview Tool Print
Paige Rose 2016-10-11
Form Name Action Form Owner Revision Date Notes
NE VR Sign Language Interpreting Request Print
Order
Vicki Rasmussen 2016-05-05
Referral Print
Data Entry
Brigid Griffin 2016-08-01 English and Spanish for all locations
Release of Information English/Spanish Print
Order
Data Entry
Vicki Rasmussen 2018-05-21
Request for Medical Information English/Spanish Print
Order
Data Entry
Angela Fujan 2017-07-31
BP/SSA 3288 Consent for Release of Information - Earnings Print
Data Entry
Carla Lasley 2018-02-12 Earnings (VR) English/Spanish
SSA 3288 Consent for Release of Information - General (VR) Print
Data Entry
Carla Lasley 2007-12-19 English/Spanish
Waiver of Parent Signature Print
Brigid Griffin 2007-07-09
Self Employment Feasibility Referral Form Print
Data Entry
Julie Shively 2017-08-16 Revised Self-Employment referral form
Agrability Referral Print
Data Entry
Angela Fujan 2014-03-31
ATP/VR Referral Print
Data Entry
Nancy Noha 2017-12-04
Consent for Paid OJE/OJT Placement Order
Paige Rose 2014-08-17
Consent for Non-Paid Exploration Assessment or Training Placement Print
Order
Data Entry
Paige Rose 2014-08-31
BP/Benefits Orientation Checklist Print
Data Entry
Carla Lasley 2018-02-01
BP/DHHS Authorization for the Disclosure of Protected Health Information Print
Data Entry
Carla Lasley 2018-06-28
Authorization for Exchange of Information-Multi Agency Release Print
Carla Lasley 2018-01-31
BP/Benefits Services Referral Form Print
Data Entry
Carla Lasley 2018-03-01
SSA 3288 Consent for Release of Information - Earnings (VR) Print
Order
Carla Lasley 2009-11-30
BP/SSA 3288 Consent for Release of Information - General Print
Order
Carla Lasley 2018-02-12
Maximus: Notification To Take Ticket Out of Assignment Print
Data Entry
Angela Fujan 2012-09-30
Mediation Referral Print
Shari Bahensky 2008-03-31
Service & Device Application Print
Nancy Noha 2014-05-31 Multi-Agency Form
Vocational Evaluation Referral - Data Entry Data Entry Paige Rose 2018-01-26
Vocational Evaluation Referral - Print Print
Paige Rose 2018-01-26
VR Criminal Background Request Print
Jen Papproth 2018-03-07
DHHS Eligibility Release of Information (ROI) Print
Data Entry
Carla Lasley 2017-04-01
Title II: Social Security Disability Insurance Work Incentives Guide - 2018 Print
Carla Lasley 2018-01-01
Title XVI: Supplemental Security Income Work Incentives Guide - 2018 Carla Lasley 2018-06-29 Revised 1616b threshold amount
Concurrent Work Incentive Guide 2018 Print
Carla Lasley 2018-06-29 Revised 1616b threshold amount-This form provides the adjusted calculation for those who receive both SSDI and SSI benefits.
Release form for Video & Media Print
Data Entry
Sandy Ham 2018-04-02
Pre-Employment Transition Services Consent & Information Release Print
Data Entry
Brigid Griffin 2017-03-11
Pre-Employment Transition Services Consent & Information Release Spanish Print
Data Entry
Brigid Griffin 2017-07-31
Section 511: Refusal of Pre-Employment Transition Services (While still in High School) Data Entry Paige Rose 2017-03-23
Refusal of Pre-Employment Transition Services (While still in High School) Print
Data Entry
Paige Rose 2017-03-01
ATP-CPAP Facility Assessment Referral Form Print
Data Entry
Nancy Noha 2017-07-18 For BAM and CPAP staff use with businesses
Pre ETS Job Exploration Referral Data Entry Paige Rose 2018-01-26
Benefits Services Providers Print
Carla Lasley 2018-03-29
BP/DHHS Authorization for the Disclosure of Protected Health Information-Spanish Print
Data Entry
Carla Lasley 2018-06-28
Form Name Action Form Owner Revision Date Notes
Section 511: Refusal of Pre-Employment Transition Services (While still in High School) Data Entry Paige Rose 2017-03-23
Section 511: Refusal to Participate Data Entry Paige Rose 2017-03-23
Section 511: Documentation Checklist for Adults Data Entry Paige Rose 2017-03-23
Section 511: Documentation Checklist for Youth (under age 24) Print
Data Entry
Paige Rose 2017-05-05
Section 511 Medically Fragile Student Letter Print
Data Entry
Brigid Griffin 2017-05-30
Section 511: Employment Not Expected from Services Letter Paige Rose 2017-06-19
Section 511: Discovery Payment Schedule Print
Paige Rose 2017-02-01
Section 511: VR Eligibility for DD Letter Print
Data Entry
Paige Rose 2017-07-18
Information and Referral (I & R) to Other Programs Print
Carla Lasley 2018-06-05 Used for CCIR appointments
Section 511: Information on Self-Advocacy, Peer Mentoring, and Self-Determination Opportunities Print
Paige Rose 2017-10-11 Used for CCIR appointments
511 Decision Tree Print
Paige Rose 2018-07-10
Form Name Action Form Owner Revision Date Notes
Self Employment Discussion Questionnaire-Data Entry Print
Data Entry
Julie Shively 2017-12-07 Use this Word version to allow for expanding data entry. Tab between fields.
Self Employment Rates & Provider Print
Judy Vohland 2018-01-01
Self Employment Personal Finance Worksheet Print
Data Entry
Judy Vohland 2017-02-07
Self Employment-Advantages Print
Judy Vohland 2017-03-01
Self Employment-GreenFlags/RedFlags Print
Judy Vohland 2016-06-09
Self Employment Feasibility Referral Form Print
Data Entry
Julie Shively 2017-08-16 Revised Self-Employment referral form
Self Employment Process Chart Print
Julie Shively 2018-01-26
Supported Self-Employment Referral Form Print
Mary Matusiak 2018-05-23
Form Name Action Form Owner Revision Date Notes
Supported Employment & Customized Employment-Intellectual Disabilities-Independent Provider Packet Print
Data Entry
Carla Lasley 2017-05-15
Supported Employment Milestone 1-Initiate Job Search Services I/DD Print
Data Entry
Carla Lasley 2017-07-17
Supported Employment Milestone 2-Employment Placement Report I/DD Print
Data Entry
Carla Lasley 2017-07-17
Supported Employment Milestone 3-Job Stabilization Report I/DD Print
Data Entry
Carla Lasley 2017-07-17
Supported Employment Milestone 5 Report - I/DD, ABI/Autism Supported & Customized Employment Print
Data Entry
Carla Lasley 2018-03-02
Payment Schedule Supported Employment Milestone ABI-ASD Print
Carla Lasley 2017-04-14
Payment Schedule Support Employment Milestone BH Print
Carla Lasley 2017-04-14
Supported Employment Milestone 4-VR Closure & SE Job Retention Plan I/DD Print
Data Entry
Carla Lasley 2017-07-17
VR Profile for Supported or Customized Employment Data Entry Paige Rose 2017-03-02
VR Profile for Supported or Customized Employment SAMPLE Data Entry Paige Rose 2017-03-02
Payment Schedule Customized Employment Milestone-I/DD Print
Paige Rose 2017-05-30
Payment Schedule Supported Employment Milestone -I/DD Print
Carla Lasley 2017-05-30
Supported Employment Milestone 30 Day Report I-DD Print
Data Entry
Carla Lasley 2018-02-01
Supported Employment Milestone 2-Customized-Employment Placement Report I/DD Print
Data Entry
Carla Lasley 2017-07-17
Section 511: Discovery Payment Schedule Print
Paige Rose 2017-02-01
Supported Employment Milestone 1 - Job Search Agreement BHABIA Print
Data Entry
Carla Lasley 2017-05-01
Supported Employment Milestone Alternative 1 - Job Retention Agreement BHABIA Print
Data Entry
Carla Lasley 2017-05-01
Supported Employment Milestone 2 - Job Placement Report BHABIA Print
Data Entry
Carla Lasley 2017-05-01
Supported Employment Milestone 3 - Job Stabilization Report BHABIA Print
Data Entry
Carla Lasley 2017-05-01
Supported Employment Milestone 4 - VR Closure & SE Job Retention Plan BHABIA Print
Data Entry
Carla Lasley 2017-05-01
Supported Employment Milestone 5 - Long Term Supports BHABIA Print
Data Entry
Carla Lasley 2017-05-01
Supported Employment Milestone 30 Day Report -I/DD Customized Print
Data Entry
Carla Lasley 2018-03-01
Supported Self-Employment Referral Form Print
Mary Matusiak 2018-05-23

Pre-Employment Transition Services

Form Name Action Form Owner Revision Date Notes
Consent for a Paid Work Based Learning Experience (14-15 y.o.) Print
Data Entry
Brigid Griffin 2017-03-01
Consent for a Paid Work Based Learning Experience (16+ y.o.) Print
Data Entry
Brigid Griffin 2017-03-01
Work Based Learning Experience Information Print
Data Entry
Brigid Griffin 2017-12-04
2017 Work Based Learning Experience Time Sheet Print
Data Entry
Brigid Griffin 2017-12-21
Work Based Learning Experience Report Print
Data Entry
Brigid Griffin 2017-03-01
Work Based Learning Experience Letter Checklist Print
Data Entry
Brigid Griffin 2017-03-03
Pre-Employment Transition Services Consent for a Non-paid Work Based Learning Experience Print
Data Entry
Brigid Griffin 2017-04-30
Work Based Learning Letter-Paid Print
Data Entry
Brigid Griffin 2017-08-30
Work Based Learning Letter-Unpaid Print
Data Entry
Brigid Griffin 2017-08-30
Consent for a Paid Work Based Learning Experience (14-15 y.o.) Spanish Print
Data Entry
Brigid Griffin 2017-07-31
Consent for a Paid Work Based Learning Experience (16+ y.o.) Spanish Print
Data Entry
Brigid Griffin 2017-07-31
Work Based Learning Experience Information Spanish Print
Data Entry
Brigid Griffin 2017-12-04
Pre-Employment Transition Services Consent & Information Release Print
Data Entry
Brigid Griffin 2017-03-11
Pre-Employment Transition Services Consent & Information Release Spanish Print
Data Entry
Brigid Griffin 2017-07-31
Pre-Ets Non Participation letter Print
Brigid Griffin 2018-04-11
Pre-Employment Transition Services Consent for Non-paid Work Based Learning Experience Spanish Print
Data Entry
Brigid Griffin 2017-04-01
Pre ETS Welcome letter Print
Brigid Griffin 2017-10-20
Pre ETS Welcome Letter Spanish Print
Brigid Griffin 2017-10-20
OOS Pre-Employment Transition Services Eligibility/Priority Group Letter (New Students) Print
Vicki Rasmussen 2018-07-11 Example of Order of Selection Pre-Employment Transition Services Eligibility/Priority Group Letter (New Students) sent out by State Office
2018 Work Based Learning Experience Time Sheet Print
Data Entry
Brigid Griffin 2017-12-21
Income under WIOA Print
Data Entry
Paige Rose 2018-04-13

Administrative

Form Name Action Form Owner Revision Date Notes
Vacation Carryover Request Print
Vicki Rasmussen
Volunteer/Unpaid Intern Print
Vicki Rasmussen This form is housed on Inside NDE.
Classification Specifications Vicki Rasmussen
Contracts, Letter Contracts, Purchasing Procedures Cathy Callaway
College Coursework Request Print
Data Entry
Vicki Rasmussen 2017-02-24
Direct Deposit Enrollment Print
Data Entry
Cinda Wacker 2013-07-31
Horizontal Wage Progression Vicki Rasmussen Contact NDE HR for this form.
Leave Advancement/LWOP Request Print
Vicki Rasmussen
I-9 Checklist Print
Vicki Rasmussen
I-9 Form & Information Print
Vicki Rasmussen
Minority, Women, Disabled Owned Designation (MWD) Print
Cinda Wacker
Merit Stipend Request Vicki Rasmussen Contact NDE HR for this form
NDE Reference Check Vicki Rasmussen
Retirement Reception Cinda Wacker Contact NDE HR for this form
State Vehicle Waiver - NDE Print
Cinda Wacker
Work Schedule Change Request (will download to your Downloads folder) Print
Vicki Rasmussen
SOS Personnel Request form (Will download to your Downloads folder) Print
Data Entry
Vicki Rasmussen
FOCUS Card Enrollment Form (Replaces AccelaPay) Print
Data Entry
Cathy Callaway 2015-11-23
ADA Guidance Print
Vicki Rasmussen 2017-02-24
Bi-Weekly Schedule (2018) Information Print
Cathy Callaway 2017-12-07
Form Name Action Form Owner Revision Date Notes
DHHS Registry Check Print
Jen Papproth 2018-03-15 VR Employees Only, Volunteers, Interns, Service Agreements
Case Review Instrument - Employment Process Print
Lindy Foley
Case Review Instrument - Vocational Evaluation Print
Paige Rose 2016-08-08 Includes Case Review-Voc Eval instructions
Case Review-Supported Employment (Milestones) Print
Data Entry
Carla Lasley 2015-06-21
Compliance Case Review Instrument Print
Angela Fujan
Confidentiality Agreement Print
Vicki Rasmussen 2018-08-13
Client Incident Report Print
Data Entry
Vicki Rasmussen
Critical Skills Checklist Print
Data Entry
Janet Drudik
Direct Purchase Agreement (DPA) Print
Data Entry
Cathy Callaway
Employee Roster Information Print
Data Entry
Vicki Rasmussen 2017-05-03
Provider Program Review-Supported Employment Print
Data Entry
Judy Vohland
Case Review-Quality Case Review Instrument (Checklist) Print
Angela Fujan 2017-03-02
Service Agreement Data Entry Cathy Callaway 2017-04-14
Team Connections Print
Data Entry
Vicki Rasmussen
Training Request Print
Data Entry
Jen Papproth
TSB Log Print
Melysa Johnson
Release form for Video & Media Print
Data Entry
Sandy Ham 2018-04-02
VR Community Connections Print
Data Entry
Vicki Rasmussen
Video Conference Participant List Print
Jen Papproth 2018-05-23
VR Job Reference Questionnaire Print
Vicki Rasmussen
New Employee Benefits Begin Schedule Print
Vicki Rasmussen 2018-01-11
I-9 Checklist Print
Vicki Rasmussen
State Vehicle Waiver - VR Print
Vicki Rasmussen 2014-06-30 Includes an extra signature line for parent/guardian for transition students.
VR Vendor Office Listing Print
Cathy Callaway 2012-12-31
Fee Schedule Exception Guide Vicki Rasmussen 2015-10-07
Suicide Call Form Print
Data Entry
Vicki Rasmussen 2015-12-16
Code of Conduct Print
Data Entry
Angela Fujan 2016-05-27
Case Review - General Print
Data Entry
Angela Fujan 2017-03-10 referral to case closure
New Hire/Employee Roster Print
Vicki Rasmussen 2017-10-03
Case Review Instrument- Task Notes Print
Jen Papproth 2017-04-20
Summary of Case Review Findings Print
Data Entry
Jen Papproth 2017-12-04
Transition Partnership Planning Form Print
Data Entry
Brigid Griffin 2017-05-01 Stand alone Planning form from the Transition Services Planner - Guide for Educators
Compliance Case Review Instrument- Pre-Employment Transition Services Print
Data Entry
Brigid Griffin 2018-04-02
Training Plan Data Entry Jen Papproth 2018-06-13
Assessment Action Plan Print
Data Entry
Jen Papproth 2018-03-28
VR Criminal Background Request Print
Jen Papproth 2018-03-07
Order of Selection (OOS) Talking Points Print
Data Entry
Lindy Foley 2018-05-03
Case Review Instrument- Clerical Associate Print
Data Entry
Jen Papproth 2018-07-18
Form Name Action Form Owner Revision Date Notes
Voter Registration Print
Vicki Rasmussen
Tax Exempt Form (Form 13) Print
Cathy Callaway 2016-12-31 Office Listing is included with the form
W4 Employee's Withholding Allowance Certificate Print
Vicki Rasmussen
W-9 & ACH Enrollment Print
Data Entry
Cinda Wacker
State Purchasing Bureau Non-CSI Justification Form Print
Data Entry
Vicki Rasmussen 2017-04-24
Bi-Weekly Schedule (2018) Information Print
Cathy Callaway 2017-12-07

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