to: Date of Change: Name of New Payee: Payee’s Phone: Address of
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Other Changes: Type: Date of Change: Multi-Month Distribution
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5928.doc
Change in status with sponsoring agency in regard to health and safety standards
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Change in operation (e.g., name change, address, telephone numbers, ownership, household members
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https://content.dcf.ks.gov/ees/KEESM/Robo04-22/Robo_04_01_22/keesm10034.htmView duplicates
This is a mutual turnaround form to be used as documentation for both EES and RS. It can be initiated by EES or RS
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_____I request a consultation to discuss
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_____ Not eligible for RS based on
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https://content.dcf.ks.gov/EES/KEESM/Appendix/R-5_EES-RS_Monthly_Communiction_Report_01-21.docxView duplicates
in the Summary of Change, special provisions are
being provided
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The MMIS spenddown claim
process will accommodate the change
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https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/2004_1001_keesm_rev_20.htmView duplicates
KANSAS LAWS AND REGULATIONS FOR LICENSING PRIVATE CHILD PLACING AGENCIES Department for Children and Families March 2022 Foster Care Licensing Division 555 SW
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Child Placement Agency Laws and Regulation Book 2022.pdf
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
Change in countable resources does not impact eligibility until next review
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address change
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change in hours of care needed/used, including if child care is no longer being used or has
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https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/CC Policies at Application, Change and Review.docxView duplicates
Initial Request Change Suspend / Terminate Date Effective: Date Effective: Date Effective
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Mentor Name: NA SSN & DOB: Address: Phone #: Email: Will the Mentor be the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7210.doc
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