(1) A vocational provider assisting the injured worker in applying for prejob accommodation assistance must submit to the department a prejob accommodation assistance application. Prejob accommodations assistance applications shall be submitted on a form prescribed by the department.

(2) The prejob accommodation assistance application shall include, but is not limited to:

(a) A document supporting the need for prejob accommodation;

(b) A description of the prejob accommodation;

(c) An itemized account of each expense to be incurred in the prejob accommodation;

(d) An ownership agreement;

(e) Physician's certification of medical necessity.