Nebraska Department of Health and Human Services Forms

This document is used for notifying the Nebraska Home and Community-Based Waiver program of a death.

This form is used for investigating and reporting cases of sudden unexpected infant death in Nebraska.

This form is used for individuals who want to apply as a respite provider in Nebraska. It is a required document for those seeking to offer caregiving services for individuals with disabilities or special needs.

This form is used for requesting funding for exceptional circumstances, including crisis respite, through the Lifespan Respite Subsidy Program in Nebraska.

This form is used for applying to the Chronic Renal Disease Program in Nebraska.

This form is used for requesting an exemption from receiving the Covid-19 vaccine in the state of Nebraska.

This document is a complaint form used in Nebraska for reporting issues or concerns.

This document is for registering for the Nebraska Public Health Data Exchange.

This Form is used for submitting a checklist and acceptance form for the Arpa Section 9817 Home and Community Based Services Home Health Provider Relief Payments in Nebraska.

This document is for requesting reimbursement for resiliency training related to Critical Incident Stress Management in Nebraska.

This Form is used for verifying the health and safety training of Child Care Subsidy Providers in Nebraska.

This document is a calendar used for tracking attendance at a child care center in Nebraska.

This document is for tracking attendance for in-home care providers in Nebraska who are exempt from needing a license.

This Form is used for keeping attendance records for exempt home licensing and family child care in Nebraska.

This form is used for applying to amend a marriage certificate in Nebraska. It is used to request changes or corrections to the information on the original marriage certificate.

This type of document is a Form CFS-1410-S for requesting financing for exceptional circumstances, including relief due to a crisis, under the Lifelong Relief Subsidy Program in Nebraska.

This document is used to apply for a license to operate a preschool in the state of Nebraska. It includes information about the facility, staff, and educational programs.

This document is a Spanish version of the application for a Family Child Care License in Nebraska. It is used to apply for a license to operate a home-based daycare facility.

This type of document is a Spanish application form for the Lifespan Respite Subsidy Program in Nebraska. It is used to apply for financial assistance to support caregivers who provide respite care services.

This document is primarily used for recording and tracking the refrigerator temperature in Nebraska once or twice a day. It aids in maintaining the appropriate temperature, ensuring the safety of stored food and health regulations compliance.

This form is used for requesting an exemption for a relative in Nebraska.

This Form is used for requesting reimbursement for pediatric CPR and first aid expenses in Nebraska.

This document is used for applying for a daycare license in Nebraska.

This document is used to apply for a Family Child Care License II in Nebraska. It is written in Spanish.

This type of document is used for modifying a request without including a household member in Nebraska.

This form is used to apply for a Family Child Care Home II License in Nebraska.

This Form is used to apply for a preschool license in Nebraska.