STATE OF NEBRASKA

DAS ACCOUNTING DIVISION

BLANK FORMS

Note: Many of these forms are in PDF format and require the use of Adobe Acrobat Reader.

Accounting Forms

Nebraska ACH Enrollment Form

CITRIX Form and Instruction

Petty Cash Fund Application (updated 4-07) and Instruction

Fund Application (Updated 3-09) and Instruction

Investment Authorization

Grant Updates – Email attachment form

Nebraska W-9

Nebraska Resale or Exempt Sale Certificate Form 13 Completed by State of Nebraska

Request for Stop Pay/Duplicate Warrant (Excel)
and Instruction

Request for Taxpayer Identification Number W-9

Request for Travel by Personally Rented or Privately Owned Airplane

Purchasing Card Account Information Form and Instructions

Example of Travel Authorization Form

(Word) and (PDF)

Warrant Cancellation Form (Excel) Updated

Warrant Cancellation Certification

Expense Reimbursement Document 2009 revised (Excel)

Expense Reimbursement Document 2010 (Excel)

Payroll Forms

Bus Pass

Commuting - Monthly Employee Report (Word)

Direct Deposit Information Form

Direct Deposit Information Form – Appointed Members of Groups Set by Statute
ie. committees, boards, and commissions

Employee Payment Transmittal Form

Employer Report of Special Wage Payments
SSA-131

Interim Direct Payment Worksheet

Interim Payroll Worksheet

Payroll Calculation Spreadsheet for 2010 (Excel)

Payroll Calculation Spreadsheet for 2009 (Excel) Stimulus use after 4/1/09

Payroll Card Information Form updated 8-11-09
and Payroll Card Instruction

Payroll Certification Form and Instruction

Request for Payroll Emergency Stop Pay/Duplicate Warrant (Excel) and Instruction

Retirement Estimator –Link to Social Security Web site

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