Contact Us
Please contact us with questions and comments regarding workers' compensation in Nebraska. We would also appreciate your feedback on our programs, products, and services.

NOTE: Do not transmit personally identifiable information (PII) such as date of birth or social security number using email, which is a non-secure means of communication. Exposing PII data by sending it in an email is a well-known identity theft risk.
Sign in to Google to save your progress. Learn more
Email *
Name: *
Telephone: *
Please provide your questions / comments below: *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Nebraska Workers' Compensation Court.