Form NDE06-015 "Claim Form for Transportation Expenses of Children With Disabilities" - Nebraska

What Is Form NDE06-015?

This is a legal form that was released by the Nebraska Department of Education - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the Nebraska Department of Education;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NDE06-015 by clicking the link below or browse more documents and templates provided by the Nebraska Department of Education.

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Download Form NDE06-015 "Claim Form for Transportation Expenses of Children With Disabilities" - Nebraska

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Nebraska Department of Education
NDE 06-015
(Revised 12/2019)
Financial Services
Date Due: February 1
301 Centennial Mall South, Box 94987
Lincoln, Nebraska 68509-4987
SPECIAL EDUCATION
Claim Form for Transportation Expenses of Children With Disabilities
Fax # (402) 472-1146
RESET FORM
September 1 through December 31
2019-2020
School Year
County/District Number
County Name
Phone Number
District Name
Address
Nebraska
Zip Code
City
State
E-Mail Address
Preparer
I
as
of the Board of Education
School District, which is District No.
, of
County, hereby
certify that this is a true an accurate report of the records and costs for the transportation of resident students with disabilities from
September through December 31.
Authorized Signature
Date
Pursuant to Neb. Rev. Stat. 79-1144 and 92 NAC 51 (NDE Rule 51), providing for reimbursement for the amount expended for actual
transportation expenses for students with disabilities, we submit herewith our claim for reimbursement payable by the State of Nebraska.
BIRTH TO AGE 5
AGES 5 TO 21
Type of Transportation
Number of Students
Number of Students
Transported
Expenditure
Transported
Expenditure
(1)
(2)
(3)
(4)
A. Transportation provided by paying
parents or guardians @ .58 cents per mile
(September 1 through December 31)
B. Transportation provided by contracting
with person, agencies or other schools
C. Transportation provided by purchasing
individual fares from common carriers
D. Transportation provided by using
vehicles operated by district submitting
claim.
E. Total Number of Children with
Disabilities Transported list in A, B, C, and
0
0
D (count each child only once).
F. Total costs for period September. 1
through December 31 listed in A, B, C, and
0.00
0.00
D.
Return Original to the Nebraska Department of Education and make a copy to retain in School File.
Nebraska Department of Education
NDE 06-015
(Revised 12/2019)
Financial Services
Date Due: February 1
301 Centennial Mall South, Box 94987
Lincoln, Nebraska 68509-4987
SPECIAL EDUCATION
Claim Form for Transportation Expenses of Children With Disabilities
Fax # (402) 472-1146
RESET FORM
September 1 through December 31
2019-2020
School Year
County/District Number
County Name
Phone Number
District Name
Address
Nebraska
Zip Code
City
State
E-Mail Address
Preparer
I
as
of the Board of Education
School District, which is District No.
, of
County, hereby
certify that this is a true an accurate report of the records and costs for the transportation of resident students with disabilities from
September through December 31.
Authorized Signature
Date
Pursuant to Neb. Rev. Stat. 79-1144 and 92 NAC 51 (NDE Rule 51), providing for reimbursement for the amount expended for actual
transportation expenses for students with disabilities, we submit herewith our claim for reimbursement payable by the State of Nebraska.
BIRTH TO AGE 5
AGES 5 TO 21
Type of Transportation
Number of Students
Number of Students
Transported
Expenditure
Transported
Expenditure
(1)
(2)
(3)
(4)
A. Transportation provided by paying
parents or guardians @ .58 cents per mile
(September 1 through December 31)
B. Transportation provided by contracting
with person, agencies or other schools
C. Transportation provided by purchasing
individual fares from common carriers
D. Transportation provided by using
vehicles operated by district submitting
claim.
E. Total Number of Children with
Disabilities Transported list in A, B, C, and
0
0
D (count each child only once).
F. Total costs for period September. 1
through December 31 listed in A, B, C, and
0.00
0.00
D.
Return Original to the Nebraska Department of Education and make a copy to retain in School File.
01/2016
INSTRUCTIONS FOR COMPLETING SPECIAL EDUCATION TRANSPORTATION CLAIM FORM FOR THE PERIOD
SEPTEMBER 1 THROUGH DECEMBER 31
1.
Claims must be received in the NDE Special Education Office on or before 5:00 p.m., February 1, to be honored for a first
semester payment.
2.
Submit claim to the NDE Special Education Office; ma ke a copy to be retained for district records.
3.
Copies of billings are not to be submitted with the first semester claim but may be required for final payment.
4.
Claims must be signed by the designated school official.
5.
If your district is claiming reimbursement that exceeds the application, please submit an amendment to the application.
Amendments should accompany the claim and require authorization from the designated school official. To amend, submit a
copy of the original application with any changes recorded on it; write "Amendment" across the top of the form; and indicate
which items have been amended. Please submit any Transportation Amendments by June 1.
6.
For each item, report the number of students Birth to Age 5 and Ages 5 to 21 by type of transportation being used. The grand
total figures represent an unduplicated count of students with disabilities being transported.
7.
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEM A:
a)
Indicate in Column (1) the number of students Birth to Age 5 and in Column (3) the number of students Ages 5 to 21 for
whom parents and guardians were reimbursed.
b) Indicate in Column (2) the expenditures for students Birth to Age 5 and in Column (4) the expenditures for students Ages
5 to 21 for the first semester. Multiply mileage by the specifed mileage allowance per mile for Birth to Age 5 and Ages 5 to 21.
8.
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEM B:
Indicate in Column (1) the number of students Birth to Age 5 and in Column (3) the number of students Ages 5 to 21 who were
transported by a private party (other than parents or guardians), an agency, or other school district. On-going contracts with
taxi or bus companies should be included herein. Mileage need not be specified. Indicate the expenditures of these contracts for
first semester in Column (2) for students Birth to Age 5 in Column (4) for students ages 5 to 21.
9.
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEM C:
Indicate in Column (1) the number of students Birth to Age 5 and in Column (3) the number of students Ages 5 to 21
transported by common carriers such as bus, taxi and airline companies for the first semester. Indicate in Column (2) the
expenditures for students Birth to Age 5 and in Column (4) the expenditures for students Ages 5 to 21.
10.
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEM D:
Indicate in Column (1) the number of students Birth to Age 5 and in Column (3) the number of students Ages 5 to 21
transported by district operated vehicles. Indicate in Column (2) the expenditures for students Birth to Age 5 and in Column
(4) the expenditure for students ages 5 to 21 for operation of such vehicles from September 1 to December 31.
11.
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEM E
Indicate in Column (1) the total number of students Birth to Age 5 listed in Items A, B, C and D. Indicate in Column (4) the
total number of students Ages 5 to 21 listed in Items A, B, C and D. If a student is listed in more than one category in either
Columns (1) or (3), count the child only once in Item E.
12.
SPECIFIC INSTRUCTIONS FOR COMPLETING ITEM F:
Indicate in Column (2) the total expenditures of Items A, B, C and D for students Birth to Age 5. Indicate in Column (4) the
total expenditures of Items A, B, C and D for students Age 5 to 21.
15.
In completing these forms refer to the following:
a)
Neb. Rev. Stat. Section 79-1127, and Section 79-1144;
b) Nebraska Department of Education 92 NAC 51 (Rule 51); and
c)
School District Transportation Application.
RETURN ORIGINAL COPY OF THE CLAIM FORM
ON OR BEFORE FEBRUARY 1, TO:
Nebraska Department of Education
Financial Services Section
P.O. Box 94987
Lincoln, Nebraska 68509-4987
Phone: (402) 471-4313
MAKE A COPY AND RETAIN IN SCHOOL FILES
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