x-noneFor use in Nebraska State courts and probation officesx-noneQuestions? Contact 402-471-3398 or nsc.courtservices@nebraska.gov x-none# of Non x-noneDate x-none-EnglishSpeakerServed x-noneActual Time Start x-noneActual Time End x-noneActual Time Worked x-nonePaid Time x-noneTotal Mileage x-nonePaid Travel Time x-noneInterpreting Time Paid x-noneHours @ ($50 for Certified, $35 for Non-Certified)x-none $ x-none* 0.25 hour (15 minutes) increments for time over the 2-hour minimum. x-noneTravel Time Paid x-noneHours @ ($40 for Certified, $28 for Non-Certified)x-none $x-noneTotal Pg x-none* Only if miles traveled for one day is over 50 miles. Conversion rate is 50 miles = 1 hour. x-none* Difference between actual and paid interpreting time is deducted from paid travel time.x-noneI x-noneMileage Paid Miles @ . per mile x-none $x-noneM x-none* Only if miles traveled from starting point to the interpreting site is over 15 miles one way. x-noneTotal Amount Claimedx-none $x-noneTotal Mail to:State Court AdministratorATTN: InterpreterPO Box 98910Lincoln, NE 68509-8910 x-noneInterpreter Namex-noneCircle One: Certified Non-Certifiedx-noneLanguage (one language per statement) x-noneInterpreter Payee # (Social Security # if don't know Payee #)x-noneEmailx-nonePhone x-noneMailing Address ( Check if new address)x-noneCity, State, Zip x-none* 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.x-none* Statements must be submitted for payment within 6 months of service.x-noneSignaturex-noneDatex-nonePage of x-noneFor Court Admin Use x-noneInterpreting Time x-noneTravel Time x-noneSTATEMENT FOR PAYMENT OF INTERPRETERS x-none(Traffic, Criminal, Protection Order, Civil, etc.) x-noneName of Court or Probation Office x-noneAuthorizing Signature (Required for Payment) x-noneType of Case x-noneVideo / Phone or Travel from to This form can be found on http://www.supremecourt.ne.gov American LegalNet, Inc. www.FormsWorkFlow.com