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Nebraska Form Center


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,000 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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(form1) First Report of Alleged Occupational Injury or Illness - 11/06
(form4) Compensation & Expense Report (Subsequent Report) - 6/06
(form10t) Termination of Corporate Executive Officer Waiver - 12/96
(form12) Record of Compensation Insurance - 6/95
(form12p) Record of Compensation Insurance (Intergovernmental Risk Management Pool) - 11/06
(form50) Choice of Doctor - 1/97
(form50-sp) Choice of Doctor—Spanish - 8/97
(form62) Independent Medical Examiner Application for Appointment - 10/06
(form63-1) Request for Independent Medical Examiner - 4/08
(form67-2) Notice of Agreement to use a Named Independent Medical Examiner - 4/08
(vr37e) Case Closure Report - 5/99
(vr39) Application for Certification - 2/07
(vr39a) Application for Renewal of Certification - 7/07
(vr42) VR Counselor Designation - 10/04
(vr42b) VR Counselor Appointment Request - 6/95
(vr42c) Agreement for the Selection of a Vocational Rehabilitation Counselor - 11/99
(vr42c-sp) Agreement for the Selection of a Vocational Rehabilitation Counselor—Spanish - 11/99
(vr43) Request for Change of VR Counselor - 6/95
(vr44) VR Plan - 9/04
Job Placement Information and Instructions - 10/05
Student Information and Instructions - 12/04
(idrform) Informal Dispute Resolution - 8/00
(2008 job search-mileage reimbursement) To report travel on and after 01/01/2008: Job Search Activity Log - Mileage Reimbursement Request (effective 01/01/2008)
(2007 mileage reimbursement) To report travel prior to 1/01/2008: Job Search Activity Log - Mileage Reimbursement Request (effective 01/01/2007)
(2008 training-mileage reimbursement) To report travel on and after 01/01/2008: Training Mileage Reimbursement Request (effective 01/01/2008)
(2007 training-mileage reimbursement) To report travel prior to 1/01/2008: Training Mileage Reimbursement Request (effective 01/01/2007)
(monthly tutor payment) Monthly Tutor Payment Form - N/D
(progress report) Instructors Monthly Progress Report - N/D
(study program) Program of Study - N/D
(end term report) Post-Secondary End of Term Report - N/D
(petition) Petition & Addendum - 1/09