Nebraska Divorce Supplemental Forms: Vital Statistics, Social Security, and Confidential Filings

Most people preparing for a Nebraska divorce focus on the Complaint for Dissolution — the main document that initiates the case. But the complaint alone won't get accepted by the Clerk of the District Court. Several supplemental forms must accompany it, and missing even one will send you home to start over.

These forms aren't complicated, but they require information you may not have at your fingertips. Gathering it before you start drafting saves a trip back to the courthouse.

The Vital Statistics Certificate

Every Nebraska divorce filing must include a completed Vital Statistics Certificate. This form has nothing to do with your legal case — it reports the dissolution to the Nebraska Department of Health and Human Services (DHHS), which maintains state marriage and divorce records.

The form asks for:

• Full legal names of both spouses (including maiden names)
• Date and place of marriage (city, county, and state)
• Date of birth and Social Security number for each spouse
• Number of prior marriages for each party (and how each ended)
• Number of children born or adopted during this marriage

DHHS uses this data for vital records — the same system that tracks births and deaths. The completed certificate gets filed with the clerk alongside your complaint and is forwarded to DHHS after the decree is entered.

What trips people up: The form requires the exact date and location of the marriage. If you were married in another state 20 years ago, you may need to request a copy of your marriage certificate to verify the details. "Approximately 2005" or "somewhere in Iowa" won't satisfy the form.

Social Security, Gender, and Birth Date(s) Form

Nebraska requires the Social Security, Gender, and Birth Date(s) form (DC 6:5.12) as part of the divorce filing. This confidential information is used by the Nebraska Department of Health and Human Services Child Support Division but is not used for other purposes unless the court orders it.

The form is required even in cases without children. It is simple — name, gender, date of birth, and Social Security number for each party — but it must be accurate. An incorrect SSN can create enforcement problems years later if custody or support modifications arise.

This form is confidential. It's sealed by the court and not included in the public case file. Your Social Security number won't appear in any publicly accessible court records.

Confidential Employment and Health Insurance Information

The Confidential Employment and Health Insurance Information form (DC 6:5.11) is also required with the initial Complaint, including in cases without children. It collects each spouse's employer and health insurance information for the court's case and support administration.

Both forms are confidential and are not part of the public record. The Social Security form supports the Child Support Division's work; the employment and health insurance form gives the court information relevant to the case.

When These Forms Are Due

All supplemental forms must accompany the initial Complaint for Dissolution when you file at the clerk's office. The clerk reviews the packet for completeness before accepting it and assigning a case number. If any required form is missing, the clerk will decline to file the complaint until the packet is complete.

This means you need to have everything ready before your first visit to the courthouse:

• Complaint (DC 6:4.1 for no children, or DC 6:5.1 for cases with children)
• Vital Statistics Certificate
• Social Security, Gender, Birth Date(s) Form (DC 6:5.12)
• Confidential Employment and Health Insurance Information (DC 6:5.11)
• Filing fee ($164, plus any county surcharge) or an approved IFP fee waiver

Getting the Forms

All supplemental forms are available for free from the Nebraska Judicial Branch website under the self-represented litigant resources section. They're organized by form number (the DC 6:4 and DC 6:5 series). Many county courthouses also have printed copies available at the clerk's window.

Download and review every form in your applicable series before you start filling anything out. Reading through the full packet first helps you identify what information you'll need to gather — marriage certificate details, employer information, Social Security numbers — so you can collect it in one pass rather than discovering gaps mid-filing.

The Nebraska Divorce Filing Process Guide covers every form in the filing packet — main and supplemental — with field-by-field guidance on what to write and which common errors trigger clerk rejections.

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