REV. Jan -2025
Page 2 of 2
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State of Kansas FC/AD NOTIFICATION OF MOVE/PLACEMENT/CHANGE PPS 5120
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Placement Name and Physical Address
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Change of status for sibling(s) remaining in the home
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5120.docxView duplicates
When a change in status occurs that does not effect the provider's eligibility to do business with the agency (i.e., - name change on license but no lapse in licensure
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https://content.dcf.ks.gov/EES/KEESM/current/keesm10030.htmView duplicates
When Used: When TANF is extended
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your household, including marriage or divorce
Change in employment or change in earnings of $100
Change of $50 dollars in unearned income
If you
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https://content.dcf.ks.gov/ees/KEESWebHelp/NonMedical-KEESWebHelp/TANF_Extension.htm
What is the Child Care Provider Handbook? 5
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SECTION II: General Information for All DCF Child Care Providers 6
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Violations of the Provider Agreement 9
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Sample Consent for Medical Care Form
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https://content.dcf.ks.gov/ees/KEESM/Robo02-25/NewForms02-25/C10.docx
Change in status with sponsoring agency regarding 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/Current/keesm10034.htmView duplicates
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
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/Robo10-22/Robo_10_01_22/keesm10034.htmView duplicates