Nebraska Department of Health and Human Services Forms

This form is used for reporting the shipment of asbestos waste in Nebraska.

This form is used for applying for membership in the Critical Incident Stress Management Program in Nebraska.

This Form is used for requesting access to birth information in Nebraska for births that occurred after September 1, 1988.

This Form is used for notifying the relevant authorities in Nebraska about a person's objection to adoption and their intent to obtain custody of a child.

This document is for requesting access to birth information in Nebraska that dates back to before September 1, 1988. It is used to obtain personal records and information related to births that occurred before this date.

This form is used for child care subsidy providers in Nebraska to enroll and bill for absent days.

This Form is used for applying for a grant to improve the quality of child care services in Nebraska. It is designed to support initiatives that enhance the overall care and development of children in childcare settings.

This document is used for applying for a grant to start or expand a child care business in Nebraska.

This form is used for requesting a relative exempt status for child care subsidy in Nebraska for in-home providers or household members.

This form is used for applying for a Child Care Fingerprint Criminal History Check for License Exempt Child Care Subsidy Provider type in Nebraska.

This document is used for obtaining consent and authorization to release information for in-home, license-exempt, family child care homes I and II, as well as child care centers in Nebraska.

This diagram provides an overview of the emergency exits in Nebraska. It shows the various exit points and pathways in different locations, helping individuals quickly locate the nearest exit in case of an emergency.

This document outlines the evacuation procedure for Nebraska in case of an emergency.

This document outlines the evacuation procedure specific to Nebraska. It provides instructions and guidelines for safely evacuating in the event of an emergency or natural disaster.

This document outlines the procedure to be followed during a lockdown situation in the state of Nebraska. It provides guidance on how to ensure the safety and security of individuals in various settings such as schools, offices, and public venues.

This document describes the relocation process in Nebraska. It provides information and instructions for individuals or families who need to move to a new location within the state.

This document describes the shelter-in-place procedure in Nebraska in case of emergency situations, such as natural disasters or a public health threat.

This document outlines the relocation procedure for moving to Nebraska. It provides information on the steps involved in relocating to the state.

This Form is used for applying to join the Medical Care Advisory Committee (MCAC) in Nebraska.

This form is used for creating an Advance Mental Health Care Directive in the state of Nebraska. It allows individuals to specify their preferences and instructions for mental health treatment in the event they become incapacitated.

This document is for notifying the Nebraska Home and Community-Based Waiver program of a participant's death. It is a draft version of the notification form.

This document is a renewal notice for medical nutrition therapists in Nebraska. It is used to inform them about the upcoming renewal deadline and the steps they need to take to renew their license.

This document is used for applying to renew the license of a Licensed Practical Nurse (LPN) in Nebraska.

This document is a Renewal Notice for Physician Assistants in Nebraska. It reminds physician assistants that their license is due for renewal and provides instructions on how to complete the renewal process.

This document is an activity report for the CISM (Critical Incident Stress Management) program in Nebraska. It provides information on the activities and progress of the program in addressing critical incident stress among individuals and communities in Nebraska.

This document is used for requesting reimbursement in the state of Nebraska. It is specific to the Certified Information Security Manager (CISM) certification.

This document is for activating the CISM (Certified Information Security Manager) certification in Nebraska.

This document verifies that a child care provider in Nebraska has received training in pediatric first aid and CPR.

This type of document is used for requesting reimbursement for Pediatric CPR/First Aid training at a Child Care Center in Nebraska.

This document verifies completion of health & safety orientation training for child care providers in Nebraska.

This type of document, called a Functional Behavior Assessment, is used in Nebraska to understand and analyze a person's problematic behavior in order to develop strategies for intervention and support.