Yes No Date of Change:Date of change: 5. Child graduated from high school
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DCF worker: DCF Office: Street Address: City, State, Zip: Telephone #: Fax
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6170.doc
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
(a) “Child placing agency” or “agency” means an association, organization, or corporation receiving, caring for, or finding homes for orphans or deprived children who are under 16 years
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FC_ChildPlacingAgencies/Child_Placing_Agencies_Regulations.pdf
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
☐ 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
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.pdf
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
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
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