This government document is issued by Nebraska Commission for Deaf and Hard of Hearing for use in Nebraska
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https://www.google.com/url?client=internal-element-cse&cx=003873714344695240192:4y6po7zbovu&q=https://ncdhh.nebraska.gov/sites/default/files/doc/SAMPLE%2520OF%2520COMPLETED%2520RURAL%2520COST%2520WORKSHEET.pdf&sa=U&ved=2ahUKEwjzrZLtlM2LAxXfhv0HHbqBPE8QFnoECAQQAQ&usg=AOvVaw1JJTboLKsw_ncrM05-jnbl