This form is to be completed and submitted to the Eligibility Payment Unit for subsidy payments to be issued
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Name of DCF staff entering the subsidy payment
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7210.docx
☐ Initial Request ☐ Change ☐ Suspend / Terminate Date Effective: Date Effective: Date Effective: Young Adult Name: SSN & DOB: Address: City/State/Zip Phone #: Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7210.doc
State of Kansas Department for Children and Families Prevention and Protection Services Independent Living Subsidy Payment Unit Notification PPS 7210 REV Jul-2025 Page 1 of 1
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7210.pdf