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/LCAF%2520COST%2520WORKSHEET_fillable.pdf&sa=U&ved=2ahUKEwiVqL3Hm82LAxUIWEEAHdOjNP84KBAWegQIAxAB&usg=AOvVaw28rn0wCnLC_PiqyIFw8aHu