Last updated: 8/13/2025
Personal And Financial Account Information
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Description
PERSONAL AND FINANCIAL ACCOUNT INFORMATION. This form is used in the Nebraska Workers’ Compensation Court to collect and record an employee’s personal and financial account information in a workers’ compensation case. It requires identifying details such as the employee’s full name, date of birth, Social Security number, or alternative identification numbers like an employment visa number, green card number, or passport number. The form also provides space to list the names and birth dates of any widow, widower, minor children, or other dependents relevant to the case. If applicable, it records protected financial account information, including the name of the entity or person associated with the account, the type of account, and the account number. www.FormsWorkflow.com
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