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Nebraska 2010 Network of Care Provider Contracts
Documents to Return With Signed Contract:
Current State of Nebraska Child Placing License (Foster Care, Group Home, Residential Safety providers only)
Current Accreditation Certification
Current Child Placing Policies and Procedures and Any Revisions
Attachment F: Direct Deposit (if any changes or not previously submitted)
Attachment G: Employer (W9) (if changes or not previously submitted)
Copy of Insurance Coverage
Attachement R: Service Area Designation Form
Attachment S: Conflict of Interest Policy
Verification and Acknowledgement Form
Documents to Return Within 30 Days of Signing Contract:
Current Recruitment Plan (Foster Care Agencies Only)
Current Training Plan
Disaster Plan (Foster Care and Group Home Agencies Only)
Current Listing of all Staff Identified By: Name, birth date, degree, numbers of years worked with the agency and background checks last date completed by specified background checks as required. (This includes both supervisory and direct care staff)
Documents and Requirements Associated with Contract, for Provider File:
Standard Contract
Individualized Agreement for Services Template
Fee Schedule
Service Requirements and Compensation for Services
Foster Care Services
Group Home/Residential Safety Services
Background Check Requirements
DHHS Performance Measures and Penalties
Boys and Girls Home Perfomance Measures and Penalties
Service Invoice
Direct Deposit
Employer (W9)
Training/Staff Development Requirements
Insurance Requirements
Confidentiality Agreement
State Contract: Service Coordination and Service Provision for Child Welfare and Juvenile Services
State Operations Manual
Incident/Critical Incident Report
Personnel File Audit Checklist
Weekly Subcontractor Employee List Format
Quarterly Foster Care Recruitment/Retention Update Format
Listing of Geopods
Service Delivery Geographic Designation Form
Conflict of Interest Policy
Agency Contact Information
Placement Agreement
Foster Parent Roles and Responsibilities