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Nebraska DDA-2 DPFS Disability Report

Applicants to Nebraska's Disabled Persons and Family Support (DPFS) program need this report to verify a medically determinable, severe, chronic disability and a need for support to avoid out-of-home placement or return to independent living. The application is not complete until DHHS receives it. The professional applies the program's disability definition and marks the functional areas affected.

Who completes it

The applicant or representative completes Section I, describing personal care needs, before taking the form to a professional. A licensed health care or medical professional completes Section II on the reverse, including the diagnosis, and signs.

Submitting and payment

How to submit it
The applicant either submits the report to the DPFS program themselves or checks a box consenting to the professional sending it directly to the DPFS program at DHHS.
Who pays
The applicant's section states that any charge for completing the report should be billed to the applicant privately.

Good to know

  • Disability for DPFS must be diagnosed by a licensed physician, registered nurse, physician assistant, psychiatrist, psychologist or physical therapist.
  • The condition must be likely to continue indefinitely and cause substantial functional limitations in at least two of eight major life activity areas.
  • The eight areas are self-care, receptive and expressive language, self-direction, learning, mobility, capacity for independent living, work skills or tolerance, and economic sufficiency.
  • Section II also asks what affects the person's ability to eat (food preparation, choking, swallowing, vision, opening containers, dentures and more) and how long you have known the applicant.

Get the official form

Download the current version from the source each time; forms change without notice.

Disabled Persons and Family Support Program Disability Report

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What is the DPFS disability definition on form DDA-2?

A medically determinable, severe, chronic condition that is attributable to mental and/or physical impairments, is likely to continue indefinitely, results in substantial functional limitations in two or more major life activity areas, and shows a need for long-term, individually planned and coordinated care, treatment, rehabilitation or other services.

What should the DDA-2 statement include?

Section II asks for a brief statement including the diagnosis, plus comments verifying the help the applicant needs with personal care to remain in an independent living situation. You also answer yes or no on the definition, check the affected functional areas and note how long you have known the applicant.

Can the provider send DDA-2 directly to DHHS?

Yes, if the applicant checked the consent box in Section I. Otherwise the applicant submits the report to the program themselves. Either way, the applicant's DPFS application is not complete until the report is received.