Vocational Rehabilitation (VR) Forms and Publications
Forms
A number of Vocational Rehabilitation (VR) forms below are in Google Forms format and may be completed and submitted directly from this website. The remainder are in PDF format and may be completed electronically, then printed and mailed. If additional space is required to complete a form, please attach the necessary information on a separate sheet(s) of paper. For more information about each form, please refer to our VR Forms Guide.
Publications
Please contact us with questions or comments.
VR Counselor Forms
Form VR-39: Application for Certification. NOTE: Sign and return the Ethical Standards and Responsibilities agreement with this application.
Form VR-39A: Application for Renewal of Certification. NOTE: Sign and return the Ethical Standards and Responsibilities agreement with this application.
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-42C: Agreement for the Selection of a VR Counselor (English and Spanish)
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 (below).
Form VR-44SI(A): Formal Training Employee Student Information and Instructions
United States Citizenship Attestation Form (English and Spanish). NOTE: This form must accompany all submissions of form VR-44: VR Plan (above). Select this link to view resources for the Systematic Alien Verification for Entitlements (SAVE) program.
Labor Market Survey. NOTE: This is a voluntary form.
Program of Study. NOTE: This is a voluntary form.