Vocational Rehabilitation
Publications & Forms

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Publications

Vocational Rehabilitation Services (PDF: 0.25 KB)
Vocational Rehabilitation Services (Spanish) (PDF: 0.25 KB)
Rules 36 - 45 (PDF: 0.25 KB)

Forms

The forms below may be completed electronically, then printed and mailed to the Nebraska Workers' Compensation Court, Vocational Rehabilitation Section, P.O. Box 98908, Lincoln NE 68509-8908. If additional space is required to complete a form, please attach the necessary information on a separate sheet(s) of paper. You may send questions or comments about these forms to the E-Mail Help Desk.

Form VR-37E: Case Closure Report (PDF: 0.5 KB)
Form VR-39: Application for Certification (PDF: 0.5 KB)
Form VR-39A: Application for Renewal of Certification (PDF: 0.25 KB)
Form VR-42: VR Counselor Designation (PDF: 0.5 KB)
Form VR-42B: VR Counselor Appointment Request (PDF: 0.5 KB). Note: Send one copy each to the Nebraska Workers' Compensation Court, Employer/Insurer/Insurer Attorney, and Employee/Employee Attorney.
Form VR-42C: Agreement for the Selection of a VR Counselor (PDF: 0.25 KB)
Form VR-42C: Agreement for the Selection of a VR Counselor (Spanish) (PDF: 0.25 KB)
Form VR-43: Request for Change of VR Counselor (PDF: 0.25 KB). Note: Send one copy each to the Nebraska Workers' Compensation Court, Employer/Insurer/Insurer Attorney, Employee/Employee Attorney, and Current Vocational Rehabilitation Counselor.
Form VR-44: VR Plan (PDF: 0.25 KB). Note: All submissions of this form must include a completed United States Citizenship Attestation Form, listed below.
United States Citizenship Attestation Form (PDF: 0.25 KB). Note: This form must accompany all submissions of Form VR-44: VR Plan, listed above.
Form VR-44S: Supplemental Billing Request (PDF: 0.25 KB)
Form VR-44SI: Student Information and Instructions (PDF: 0.25 KB)
Form VR-44JPI: Job Placement Information and Instructions (PDF: 0.25 KB)
Job Search Mileage Reimbursement Request:
- Select this link to report travel on and after 01/01/2010:
  Job Search Activity Log—Mileage Reimbursement Request, effective 01/01/2010. (PDF: 0.25 KB)
- Select this link to report travel prior to 01/01/2010:
  Job Search Activity Log—Mileage Reimbursement Request, effective 01/01/2009. (PDF: 0.25 KB)
GED, ESL, ABE Training Mileage Reimbursement Request:
- Select this link to report travel for GED, ESL, ABE Training on and after 01/01/2010:
  GED, ESL, ABE Training Mileage Reimbursement Request, effective 01/01/2010. (PDF: 0.25 KB).
- Select this link to report travel for GED, ESL, ABE Training prior to 01/01/2010:
  GED, ESL, ABE Training Mileage Reimbursement Request, effective 04/2009. (PDF: 0.25 KB).
Note: Attach completed GED, ESL, ABE Training Attendance Log (PDF: 0.25 KB) when reporting travel for GED, ESL, ABE Training.
Post-Secondary Training Mileage Reimbursement Request:
- Select this link to report travel for Post-Secondary Training on and after 01/01/2010:
  Post-Secondary Training Mileage Reimbursement Request, effective 01/01/2010. (PDF: 0.25 KB)
- Select this link to report travel for Post-Secondary Training prior to 01/01/2010:
  Post-Secondary Training Mileage Reimbursement Request, effective 04/2009. (PDF: 0.25 KB)
Monthly Tutor Payment Form (PDF: 0.5 KB)
Instructor's Progress Report (PDF: 0.5 KB)
Program of Study (PDF: 1.0 KB). Note: this is a voluntary form.
Post-Secondary End of Term Report (PDF: 0.25 KB). Note: this is a voluntary form.