Type the name of the Social
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Effective date of this payee change
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Provide a brief explanation for change, ie, child entered DCF custody on 9/15/06; child
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[same as selection for ‘old address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5928_instr.pdf
Rev. 7-07 TO: FROM: ADDRESS: ADDRESS: I
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INFORMATION: Name: Case Number (If Known): Medicaid ID #: Address Change: Date: Responsible Person or Alternate Contact Change: Date: II
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3161NOTIFICATION_OF_MEDICAID7_07.pdfView duplicates
to identify strategies to address recruitment, retention, hiring incentives, caseload size
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KRS Response: KRS worked with SRC to address recruitment during 2021
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We had proposed to SRC to
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https://www.dcf.ks.gov/services/RS/Documents/VR portion of the state plan 2022-2023 (Mod).pdf
State of Kansas Department for Children and Families Prevention and Protection Services INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN
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Address
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Placement Change
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Effective Date of Change
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_9000_Forms/PPS9135.pdf
Family Services will coordinate to address the employment and/or post-secondary education
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A systems change initiative with community developmental disability organizations or their
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https://www.dcf.ks.gov/services/RS/Documents/SP-PDF/4.8(b)(1)_Cooperative-agreements_not_WIA.pdf
This service delivery model is part of the Great Expectations systems change initiative
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Address responsibility of the providers to coordinate with the community service system
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https://www.dcf.ks.gov/services/RS/Documents/State Plan 2014-2016/4.8(b)(4)_Coop_agreements_SE.pdf
Payee Change
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Address of New Payee
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Reason for Change
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Placement Change
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Old Address
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Income Change
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Resource Change
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Name & Address of School
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DCF: For clients 17-1/2 complete and mail
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Date of Change
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5928.pdf
Email address
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following changes and return to the designated office within thirty (30) days of the change
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Date of Change
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Street Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6170.pdf
Facility Name: Licensed Program Type: Facility Address: License Number: I/we request an
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each request is to increase capacity, expand the age range, or to change the living units
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 057 Amendment Facilities.pdf
Required Elements for Submission of the Unified or Combined State Plan and Plan Modifications under the Workforce Innovation and Opportunity Act
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States must have approved Unified or
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https://www.dcf.ks.gov/services/RS/Documents/WIOA Combined Portion of State Plan ps 12-14-19.pdf