THIS IS A GOVERNMENT COMPUTER SYSTEM. Unauthorized access, use, misuse, or modification of this computer system or of the data contained herein or in transit
to/from this system constitutes a violation of Title 18, United States Code, Section 1030, and may subject the individual to Criminal and Civil penalties
pursuant to Title 26, United States Code, Sections 7213(A), 7213A (the Taxpayer Browsing Protection Act), 7431 and Health Insurance Portability and Accountability
Act of 1996. If monitoring reveals possible evidence of criminal activity, such evidence may be provided to Law Enforcement Personnel. Additional information may be
found at the Nebraska DHHS System Website Disclaimer
If you experience difficulty downloading forms from this site, please be sure you have the most current
version of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.