Complete this form or go on-line at www.dcf.ks.gov to apply
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Daytime Phone: Message Phone: Home Address: City: Zip: Mailing Address (if different): City: Zip: Suspicion-based drug
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3100_9_grandparents_as_caregivers_application07-17.pdfView duplicates
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
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
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
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
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
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.doc