Return-to-Work Services (Vocational Rehabilitation) Publications and Forms
The Vocational Rehabilitation (VR) 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 contact us with questions or comments about these forms.
VR Case Closure Forms
VR Counselor Forms
Form VR-42B: VR Counselor Appointment Request. NOTE: Send one copy each to the Nebraska Workers’ Compensation Court, Employer/Insurer/Insurer Attorney, and Employee/Employee Attorney.
Form VR-43: Request for Change of VR Counselor. NOTE: Send one copy each to the Nebraska Workers’ Compensation Court, Employer/Insurer/Insurer Attorney, Employee/Employee Attorney, and Current Vocational Rehabilitation Counselor.
VR Plan Forms
Form VR-44: VR Plan. NOTE: All submissions of this form must include a completed US Citizenship Attestation Form, listed below.
Labor Market Survey. NOTE: This is a voluntary form.
Program of Study. NOTE: This is a voluntary form.
Program of Study Template. NOTE: This is a voluntary form.
United States Citizenship Attestation. NOTE: This form must accompany all submissions of Form VR-44: VR Plan, listed above. Select this link to view applicant resources for the Systematic Alien Verification for Entitlements (SAVE) program.
Form VR-44SIC: Supportive Services Student Information (GED, ELL, ABE, Other)
Form VR-44SID: Supportive Services Student Information (Tutor, OJT, Volunteer, Other)