Nebraska Form DC 6:10.1 — Temporary Delegation of Parental Powers

You have heard that Nebraska provides a free form for delegating parental powers to a grandparent or relative, and you want to find it. The form is called DC 6:10.1, it is published by the Nebraska Judicial Branch on their self-help portal, and it is the official instrument for a temporary delegation of parental powers under Neb. Rev. Stat. § 30-2604.

Where to Get Form DC 6:10.1

The Nebraska Judicial Branch Self-Help Center provides the English Form DC 6:10.1 as a free download, with translations available in Spanish, Arabic, and Vietnamese. The form must be completed in English.

Search the Nebraska Judicial Branch website for "Temporary Delegation of Parental Powers" under the Self-Help Forms section, or ask a County Court clerk's office for a printed copy.

What the Form Contains

Form DC 6:10.1 is the standard template for executing a power of attorney under § 30-2604. It includes fields for:

• The name of the delegating parent or guardian
• The name of the designated caregiver (the person receiving authority)
• The child's name and date of birth
• A delegation of the parent's powers regarding the child's care, custody, and property, except consent to marriage or adoption
• The signing date, from which the form's six-month maximum term runs
• A notarization block for the parent's signature

The form is designed to be completed without an attorney. A separate instruction sheet, DC 6:10.1a, explains how to fill it out and where the parent should sign and date it.

How to Fill It Out Correctly

The form is straightforward, but there are several points where mistakes cause problems downstream:

Identify the delegating parent. The parent or legal guardian who currently holds custody signs the form. If both parents share legal custody, best practice is for both to sign. A single parent's signature when the other parent has joint custody and objects can lead institutions to reject the document.

Review the scope. The standard form delegates all of the parent's powers regarding the child's care, custody, and property, except consent to marriage or adoption. Make sure this full scope matches what the parent intends before the parent signs; the form does not provide a menu for selecting only certain powers.

Date the form. The standard Form DC 6:10.1 uses the signing date and states that the delegation lasts no more than six months beyond that date; it has no separate end-date field. Section 30-2604 does not provide a military extension. Its separate one-year provision applies only to a parent or guardian delegating authority to a non-ward 18-year-old to consent to that teen's own healthcare and medical treatment.

Get it notarized. This is not optional. A § 30-2604 delegation must be acknowledged before a Notary Public. Witness signatures alone do not satisfy the statutory requirement. Banks, UPS stores, and some libraries offer notary services. If the parent is incarcerated, Nebraska Department of Correctional Services facilities maintain staff or visiting notaries.

Common Mistakes

Filing it with the court. Form DC 6:10.1 is an out-of-court document. You do not file it with the County Court or any state agency. Caregivers who bring it to the court clerk's office for filing are told there is no filing procedure, which sometimes creates confusion about whether the form is valid. It is valid — it just stays in your hands, not in a court file.

Confusing it with a guardianship petition. The form delegates existing parental authority temporarily. It does not create a new legal custody relationship, and it does not require a court hearing. If you need authority that lasts longer than six months or you need it without the parent's cooperation, a guardianship petition under § 30-2608 is a separate, court-filed process.

Using an out-of-state template instead. National legal form websites sell generic "Caregiver Authorization Affidavits" or "Minor Medical Consent" templates that have no statutory basis in Nebraska. Nebraska does not recognize caregiver affidavits. Form DC 6:10.1 under § 30-2604 is the correct instrument.

After Completing the Form

Once notarized, make certified copies and distribute them to:

• The child's school district (enrollment office and, if applicable, the athletic office)
• The child's pediatrician, dentist, and any specialist
• The child's health insurer
• Any after-school program or childcare provider

Keep the original in a safe, accessible place. You will need to present it on demand when institutions ask for proof of authority.

Mark your calendar for the renewal date — the POA expires automatically at the end of the specified term, and there is no grace period or automatic extension. The School and Medical Consent guide for Nebraska includes a renewal tracker and the complete execution checklist so nothing slips through the six-month cycle.

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