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  NE Contract Information



Nebraska 2010 Network of Care Provider Contracts


Verification and Acknowledgement


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