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
move to new state New Address: Child-only move to new state New Address: Reason: Family new phone/email New
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_9000_Forms/PPS9121.doc
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
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.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
Mental Health Provider Email Address
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Placement Address
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School Address
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would then be the school in which the child is enrolled at the time of the placement change
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If yes to questions 4 and
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5254.docx
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