Shared Living Documents
Welcome to Extended Families of Nebraska’s document storage page for Shared Living Providers. It is our goal to provide you with all of the documents you may need to do your job.
Shared Living payments are not considered taxable income. This is detailed in Section 131 of the IRS code. This can put our Shared Living Contractors in unique situations.
See below for resources, and if you have any questions, feel free to contact Abigail Woods, Business Director.
COVID-19 Economic Impact Payments
This link gives directions on how to submit for the Economic Impact Statements if you did not file income taxes in 2018 or 2019 and did not receive Social Security benefits.
Medicaid & Marketplace Insurance
According to this fact sheet, difficulty of care payments should not be considered when calculating gross income for Medicaid and Marketplace insurance applications. Click here for guidance.
Physician Contact Form
Annual Physical Form
Medication Review Form
Dental Appointment Form
Vision Appointment Form
Frequent Appointment Form
Petty Cash Ledger
Day Services Billing Statement
Spend Down Ledger
Functional Assessment Questionnaire
Residential Preference Assessment
Life Skill Inventory
Quick Screen Assessment
Fast Behavioral Assessment
Back-Up Staff Packet
Adult In Home Packet
CPR/First Aid Training
Drug & Alcohol Test Consent
APS/CPS Check Instructions
2021 EFN Pay Calendar
Drug Free Workplace Notification
Essential Screens Disclosure & Authorization
2022 EFN Pay Calendar
Notice of Arrest
Personnel documents can turned into your Residential Coordinator or submitted to Tiffany Phelps, Personnel & Facilities Coordinator, via scomm, via fax to (402) 975-2293, or via mail to 4525 F Street, Lincoln, NE 68510.
GER Guide–Updated August 2020
Provider and State Policies
EFN Policy & Procedures
State of Nebraska 404 Regulations
State of Nebraska 403 Regulations