Division of Developmental Disabilities 

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Information & Forms

This webpage provides access to information and forms through the DHHS Developmental Disabilities Division. If you have questions about items posted on this page, please contact the DD Division at 402-471-8501.

Trainings

FAQs

DOJIE Monitoring Team Reports
Title 404 NAC Survey Forms
 
Renewal Application for Title 404 NAC Certification:             MS Word Format
                                                                                 PDF
 
The following forms are given as information only. They are completed by DHHS-DD Surveyor Consultants. Forms in this section are currently under revision.

 


 Guidance for Providers

Contract for Criminal History Backgroud checks with Accurate Background LLC.                                    Effective January 1, 2015 - April 25, 2017

 

PDF

​Specialized Service Provider Guidance to: Authorizations, Billing Guidelines, Service Definitions and Claims Processing.                                                  Effective July 1, 2015

 

 PDF PDF

Nebraska DD Adult Day Waiver.                                  Effective January 1, 2011

 

 PDF PDF

Nebraska DD Adult Comprehensive Waiver.                Effective January 1, 2011

 

 PDF PDF

MC-40 Developmental Index for DD Waiver Eligibility 09-2011

 PDF PDF


Notification of Death Form
  Provider Report to Notify of Death of Individual
PDF 
​​Technical Assistance Form
 Contact Technical Assistance MS Word Format
Individual Budget Amount (IBA)
​ IBA Exception Flow Chart PDF
​ IBA Exception Request Form Instructions IBA Exception Request Instructions - July 2015
​ IBA Exception Request Form IBA Exception Request - July 2015

Medicaid Waiver Medical Assessment Form

​ For Physician to Submit with Claim PDF

Contact Us
Nebraska Department of Health & Human Services
Division of Developmental Disabilities
P.O. Box 95026
Lincoln, NE 68509
(402) 471-8501

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