Fill and Sign the For Use in Nebraska State Courts and Probation Offices Form

For use in Nebraska State courts and probation offices Questions? Contact 402-471-3398 or nsc.courtservices@nebraska.gov# of Non Date -English Speaker Served Actual Time Start Actual Time End Actual Time Worked Paid Time Total Mileage Paid Travel Time Interpreting Time Paid Hours @ ($50 for Certified, $35 for Non-Certified) $ * 0.25 hour (15 minutes) increments for time over the 2-hour minimum. Travel Time Paid Hours @ ($40 for Certified, $28 for Non-Certified) $ Total Pg* Only if miles traveled for one day is over 50 miles. Conversion rate is 50 miles = 1 hour. * Difference between actual and paid interpreting time is deducted from paid travel time. IMileage Paid Miles @ .58 per mile $ M* Only if miles traveled from starting point to the interpreting site is over 15 miles one way. Total Amount Claimed $ Total Mail to: State Court Administrator ATTN: Interpreter PO Box 98910 Lincoln, NE 68509-8910 Interpreter Name Circle One: Certified Non-CertifiedLanguage (one language per statement )Interpreter Payee # ( Social Security # if don't know Payee # )Email Phone Mailing Address ( ___Check if new address ) City, State, Zip * Statements must be received by the Court Administrator by the 7th of each month for the same month processing. Please send original statements and keep a copy for your records. * Statements must be submitted for payment within 6 months of service. Signature DatePage ______ of _______ For Court Admin UseInterpreting Time Travel TimeSTATEMENT FOR PAYMENT OF INTERPRETERS (Traffic, Criminal, Protection Order, Civil, etc.) Name of Court or Probation Office Authorizing Signature (Required for Payment) Type of Case Video / Phone or Travel from to This form can be found on http://www.supremecourt.ne.gov AD 2:05 Rev. 01/19 Statement for Payment of Interpreters