Nebraska Department of Health and Human Services Forms

This form is used for applying for a respite subsidy in Nebraska.

This form is used for applying for a certified copy of a death certificate in the state of Nebraska.

This Form is used for applying for an amendment in Nebraska.

This document is a record-keeping tool used in Nebraska for managing financial transactions. It helps individuals and businesses track their income and expenses.

This document is used to record the statement of a witness to an accident that occurred in Nebraska. It provides valuable information about what happened during the incident.

This document is for reviewing the orientation statements of understanding for directors in Nebraska. It ensures that directors understand their roles and responsibilities.

This form is used for reporting law enforcement contact in the state of Nebraska.

This document guides you on how to change the ownership of an existing child care program in Nebraska. It provides the necessary instructions and requirements for this process.

This document is used to authorize the release of personal information in the state of Nebraska.

This form is used for keeping a record of immunizations received in the state of Nebraska.

This Form is used for submitting an Alternative Compliance Request in the state of Nebraska.

This form is used for documenting fire and tornado drills in Nebraska. It allows organizations to record the date, time, and details of each drill to ensure compliance with safety regulations.

This Form is used for applying for financial assistance benefits in Nebraska. It is specifically for Spanish speakers.

This form is used for applying for economic assistance benefits in Nebraska.

This Form is used for applying for Nebraska Medicaid for individuals who are aged and disabled in Nebraska.

This form is used for applying for Medicaid and Insurance Affordability Programs (Financial Assistance) in Nebraska.

This form is used for providing information about the current job and income of extra persons in a household in Nebraska.

This Form is used for requesting verification of emergency assistance in Nebraska.

This document is used for keeping track of income and expenses for self-employed individuals in Nebraska who are seeking economic assistance.

This document is used to request verification of work history in the state of Nebraska.

This document is used for the Notification of Kinship Guardianship Assistance Program (Kingap) in Nebraska. It provides information about financial assistance available to relatives who become the legal guardians of children in their care.

This form is used for changing your name and/or re-issuing a credential in the state of Nebraska.

This document is used for requesting reimbursement for pediatric first aid and CPR training expenses incurred by a child care center in Nebraska.

This Form is used for conducting a Regulations Compliance Review for License Exempt Providers in Nebraska.

This document is used for verifying the completion of health and safety orientation training for child care subsidy providers in Nebraska.

This form is used for in-home child care providers in Nebraska to complete a self-certification checklist. It ensures that providers meet the necessary requirements for operating an in-home child care facility.

This form is used for applying for a Child Care Fingerprint Criminal History Check in Nebraska.

This form is used for requesting a relative exemption for child care subsidy in Nebraska for license-exempt and in-home providers.

This document is for verifying the completion of pediatric CPR/First Aid training for child care providers in Nebraska.

This form is used for reviewing licensing compliance with regulations for a Home Child Care II facility in Nebraska.

This form is used for regulations compliance review licensing of child care centers in Nebraska.

This form is used for conducting a compliance review for licensing regulations in Nebraska for Family Child Care Homes (FCCH).

This Form is used for conducting a compliance review of licensing regulations for school-age only centers in Nebraska.

This document gives consent and authorization for the release of information for Family Child Care Homes I and II in Nebraska.

This form is used for reporting health information in the state of Nebraska. It is used to gather and document medical information for various purposes, such as insurance claims or medical research.

This form is used for conducting a compliance review for licensing a preschool in Nebraska. It serves as a checklist cover sheet for regulations compliance.

This form is used for maintaining records of children in Nebraska. It includes information about their personal details, medical history, and any other relevant information.

This form is used for making changes to the household members or staff in a family child care home in Nebraska.