1 Provider’s Name: Month: Provider’s E-mail: Year: List all foster
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Child #1’s Name: Hourly Rate: For DCF Use Child #2’s Name: Hourly
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https://www.dcf.ks.gov/services/PPS/Documents/FY2022DataReports/Public Website Documents/5828e-CCEPP Timesheet.pdf
State of Kansas PPS 5325 Department for Children and Families REV 10/12 Prevention and Protection Services Page 1 of 1 (This form
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E-mail address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5325.pdf
Department for Children and Families REV 10/22/21 Prevention and Protection Services Timesheet Page 1 of 1
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Provider’s Name: E-mail: Month: Address where care occurs: Year
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/5828E.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Foster Care Eligibility Redetermination
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PPS 5425A REV Jan 2014 Period Under Review
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E-Mail Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5425A.pdf
State of Kansas Appendix 5U Department for Children and Families July 2014 Prevention and Protection Services
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E-mail address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5U.pdf
State of Kansas Adoption Exchange Child Status Update Form
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PPS 5315 Department for Children and Families REV July 2014 Prevention and Protection
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E-mail address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5315.pdf
State of Kansas Department for Children and Families Prevention and Protection Services CCEP Program Child Care Provider Agreement PPS 5258b REV
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E-mail of Childcare Provider
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https://www.dcf.ks.gov/services/PPS/Documents/FY2022DataReports/Public Website Documents/5258b-CCEPPChild Care Provider Agreement.pdfView duplicates
State of Kansas PPS 8400F Department for Children and Families 1/2023 Prevention and Protection Services Page 1 of 19
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Staff Secure Facility (SSF) Site Visit Tool
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_8000_Forms/PPS8400F.pdfView duplicates
Page 1 of 4 State of Kansas
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Send copy to: State of Kansas Guardianship Program
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E-mail address
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I. REFERRAL INFORMATION (completed by DCF
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Address (facility, state, city, county & zip code
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10600.pdf
State of Kansas PPS 5927A Instructions Department for Children and Families Rev. October
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Accountant at bottom of Worksheet and e-mail Worksheet with attachments (if applicable) to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5927A_Instr.pdf