Placement Change
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Send Medicaid card to the current placement address indicated above
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Name of Insurance Company: Insurance Company's Address: Employer: Medical: Yes No
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5460.doc
Yes No Date of Change: Date of change: 6. Youth became emancipated
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Yes No Date of Change: Date of change: 9. Youth has accessed Independent Living Services and
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6320.doc
Department for Children and Families Kansas Laws and Regulations for Juvenile Crisis Intervention Centers JUNE 2024-A
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following terms and definitions shall apply
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Juvenile Crisis Intervention Center Laws and Regulations June 2024-A.pdfView duplicates
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/Robo10-24/Robo_10_01_24/keesm10034.htmView 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.pdfView duplicates
AS THE SOUL FAMILY LEGAL PERMANENCY RESIDENTIAL CUSTODIAN: (initial each statement
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______I have received a copy of the PPS 6320, SOUL FAMILY LEGAL PERMANENCY Change Status Form
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6302.docView duplicates
Complete the section(s) regarding the change(s) you are reporting
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Change in the number of hours that child care is needed or used
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☐ Address Change
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What is your new address
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-1512.docxView duplicates
KANSAS LAWS AND REGULATIONS FOR LICENSING RESIDENTIAL CENTERS AND GROUP BOARDING HOMES FOR CHILDREN AND YOUTH
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permit, and each licensee that wants the department to display the address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Regulations GBH and Residential Centers 8.24.pdf
process outlines the processes when a consumer on a LIEAP case reports a change in address
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not run EDBC if the only update is an address change, unless the address is out of state
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https://content.dcf.ks.gov/ees/KEESWebHelp/NonMedical-KEESWebHelp/LIEAP_Change_in_Address_Process.htm
Do NOT change the address of a child in Foster Care
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If the consumer/household did not report the change of address to the agency AND did not respond to
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https://content.dcf.ks.gov/ees/KEESWebHelp/NonMedical-KEESWebHelp/Returned_Mail_Process.htm