Division of Developmental Disabilities 

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Forms and Information

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.



DOJIE Monitoring Team Reports
Title 404 NAC Survey Forms
Renewal Application for Title 404 NAC Certification:             MS Word Format
The following forms are given as information only. They are completed by DHHS-DD Surveyor Consultants. Several of the forms in this section are currently being reviewed and may be revised.



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



​Specialized Service Provider Guidance to: Authorizations, Billing Guidelines, Service Definitions and Claims Processing.                                                  Effective July 1, 2014



Nebraska DD Adult Day Waiver.                                  Effective January 1, 2011



Nebraska DD Adult Comprehensive Waiver.                Effective January 1, 2011



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


Notification of Death Form
  Provider Report to Notify of Death of Individual
​​Technical Assistance
 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

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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