Offical Nebraska Government Website

Online Forms

Complete list of all downloadable applications and forms from the Financial Responsibility Division


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Title Name
ACCIDENT - Affidavit of Dormancy for Unsatisfied Judgment 
ACCIDENT - Installment Agreement Form 
ACCIDENT - Installment Agreement Form for Unsatisfied Judgment 
ACCIDENT - Release Form for No Claims Filed 
ACCIDENT - Release Form for One/Two Year Affidavit 
ACCIDENT - Release Form for Parent / Guardian of a Minor 
ACCIDENT - Release Form for Property Damage/Injury 
ACCIDENT / NO PROOF OF INSURANCE - Letter of Verification  
ACCIDENT / NO PROOF OF INSURANCE - Letter of Verification (Interactive) 
ALR - Petition for Arrest date 01/01/2012 and after 
ALR - Petition for Arrest date on or prior to 12/31/2011 
EMPLOYMENT DRIVE PERMIT - Procedural Bulletin / Application for ALR (2011 arrest dates) 
EMPLOYMENT DRIVE PERMIT - Procedural Bulletin / Application for Point Revocations 
EMPLOYMENT DRIVE PERMIT - Procedural Bulletin / Application for Support 
INTERLOCK - 2009 IIP Chart arrest dates 01/01/2009 to 05/13/2009 
INTERLOCK - 2009 IIP Chart arrest dates 05/14/2009 to 07/14/2010 
INTERLOCK - 2010 IIP Chart arrest dates 07/15/2010 to 12/31/2011 
INTERLOCK - 2012 IIP Chart arrest dates 01/01/2012 and after 
INTERLOCK - Application for Indigent Interlock 
INTERLOCK - Billing Invoice for Interlock Providers 
INTERLOCK - Ignition Interlock Permit Application 
MEDICAL HARDSHIP PERMIT - Procedural Bulletin and Application 
MISCELLANEOUS - Affidavit of Lost License 
MISCELLANEOUS - Fax Consent Form 
SR FILINGS - Signature Authorization Letter (interactive)