Nebraska DHHS: Asbestos Control Program: Asbestos Forms

Asbestos Forms

	* Form 1	NEW Application for Initial License or Renewal of License for Business Entities Performing Asbestos Projects, and for Waiver of License for Business Entities Not Primarily Engaged in Asbestos Projects Forms
	* Form 2	NEW Application for Waiver Forms: Anything not listed in the regulations such as 10-day waiver, waiver not to poly walls, waiver not to wear PPE during prep work, waiver to use splash guards only etc.
	*Form 3&4	NEW Application for Initial Asbestos Occupation Licensure and Limited Occupation Licensure forms.
	*Form 3&4 (Reinstatement)	NEW Application for Reinstatement to practice as an asbestos Occupation forms (Revoked, Expired, Placed on Inactive Status, Lapsed or Voluntary surrender without disciplinary action)
	* Form 5	NEW Asbestos Project Notification Forms
	* NESHAP	NESHAP Forms: Notification of demolition and renovation (needs to be filed regardless of the presence of asbestos)
	* Form 5A	Supplemental Information required when the NESHAP notification is substituted for Form 5.
	* Form 6	Application for Asbestos Occupation Course Approval Forms
	* Form 7	Application for Emergency Waiver of License Forms

Forms (* asterisk fillable forms) may be completed on-line, however, they cannot be submitted via e-mail due to the fact that all applications and forms require original signatures. If you complete the form on-line, you must print the form and mail it to the address below.

NEW Form 5, Form 2, and the NESHAP form can be scanned and emailed, faxed, mailed (via USPS Certified Mail- Return Receipt Requested, if desired) or hand delivered.

Nebraska Department of Health & Human Services
Division of Public Health, Environmental Health Unit
Office of Environmental Health & Indoor Air
Asbestos /Lead-Based Paint Program
301 Centennial Mall South, P.O. Box 95026
Lincoln, Nebraska 68509-5026
Phone: (402) 471-0386 Fax: (402) 471-8833
Toll Free 888-242-1100 ext 1 in Nebraska only
E-mail: bobbie.mills@nebraska.gov

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Asbestos Program Page