for Amendment Use this form to request a change of the family foster home license capacity
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Submit the completed request and supporting documents to DCF.FCLExceptions@ks.gov
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Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 407 Family Foster Home Request for Amendment.pdf
☐ Change of Child Placing Agency Name
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☐ Change of program type
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Agency Name: Licensed Program Type: Facility Address: License Number: I/we request an
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 652 Amendment for CPA.pdf
Section I: Check the box if this is a Change of Venue case and send the PPS 5110 to both
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Enter the name, address and telephone number, pager number or cell phone number and
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5110_Instr.pdf
Department for Children and Families IHI www.dcf.ks. g ov fJ Foster Care Licensing Division: 555 SW Kansas Avenue, 2nd Floor Topeka, KS 66603 Kansas Laws and Regulat ions for Juvenile
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Juvenile Crisis Intervention Center Laws and Regulations June 2024.docx.pdfView duplicates
List of suggested bidders, including name, address and e-mail address if available
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weaknesses of each proposal with an attempt to address items including (but not limited to
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https://www.dcf.ks.gov/Agency/Testimony/Documents/2017/2017 Session DCF Testimony to House Federal and State Affairs on HB 2201.pdf
KANSAS DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES
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Please address referrals or questions to the appropriate staff below
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72
Regulation 8 -- Change of Placement Purpose
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https://www.dcf.ks.gov/services/PPS/Documents/ICPCtrainingmanual.pdf
FCL 002 Rev 2/2019 Page 1 OF 1 KANSAS
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Initial application (new facility, move, or change of ownership
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CURRENT ADDRESS
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Street Address City State Zip
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_002_Individual_Background_Check_Request.pdfView duplicates
: When submitting an application, either an initial or renewal, do I need to have all documents
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also submit documents via fax at (785)296-8609 or by sending them to the following address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FAQ.pdf
State of Kansas Adoption Exchange Child Status
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E-mail address
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Change of Venue (when that venue is moved to another contractor
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Name of new contractor: Date of change of venue
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5315.pdf
may be or has been subject to a name change at the time of adoption; the party requesting
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this Authorization with the final decree of adoption verifying a change of name, if any
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5365.pdf