LAST
First
M.I.
Case #
Social Security #
ADDRESS
STREET
CITY
ST
ZIP CODE
Other Application Signer:
Address, if different:
Worker
Phone
Supervisor
Date
…
https://content.dcf.ks.gov/EES/KEESM/Miscform/FRS1_Referral_of_Alleged_Client_Fraud.xlsView duplicates
Fiscal Year
Building
Street Address*
REVISION #:
Between Kansas Department for Children and Families &
*physical address required, including 9-digit zip code
City
…
https://www.dcf.ks.gov/Agency/Operations/Documents/Contract Revision(OGC-2005).xls
Year (from/to)
Building
Street Address*
REVISION #:
Between Kansas Department for Children and Families &
*physical address required, including 9-digit zip code
City
…
https://www.dcf.ks.gov/Agency/Operations/Documents/Revision(OGC-1008.3).xlsView duplicates
of Selection
Economic Need
Status Change
Client History
Case Transfer
3. AUTHORIZATION
…
EXISTING APPLICATION
VIEW APPLICATION
UPDATE ADDRESS ONLY
DELETE APPLICATION (PRIOR TO
…
https://www.dcf.ks.gov/Agency/Operations/Documents/Appendix C KMIS Outline.xls
Benefit Month
Employee
Employer
Employer's Address
Hours Scheduled
Frequency Paid
Pay Day
…
Notes
LOCAL AGENCY USE
Initial
Review
IR
Change
(Last)
(First)
Best Estimate
Past 30 Days
…
https://content.dcf.ks.gov/EES/KEESM/Appendix/W-3MissingCheck.xlsmView duplicates