Non-KORA Agency Records Request Form * REQUESTOR INFORMATION
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Requestor Work Email
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Please provide the following information on the person whose Kansas DCF case history is being
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https://www.dcf.ks.gov/Records/Documents/Non-KORA-Agency-RecordsRequestForm.pdf
be sent to the mailing address or email listed above with appropriate payment (see Payment
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Return Results by: Encrypted email (list if different than above): Postal Mail
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https://www.dcf.ks.gov/Agency/Operations/Documents/OBI/OBI_1011_CAN_ROI.pdf
c. Issue a reply to the requesting email stating whether the request is approved or denied
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d. Send the return email response within 1 hour of the complete exception request being
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Emergency Afterhours Over Capacity Exceptions.pdf
Agency name Agency mailing address Email address: Will return via Encrypted email unless marked otherwise
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/OBI10400 Adult Registry ROI.pdf
A. Case Information (to locate case) B. Who is the
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Social Security Number Phone Email Street Address
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Printed Name of FC CMP/CPA Representative Representative Contact Email
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https://www.dcf.ks.gov/services/PPS/Documents/FC-CC Change Form.pdfView duplicates
KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
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Mailing Address: PO BOX 1424 Topeka, KS 66601 Physical
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Website: http://www.dcf.ks.gov Email: DCF.FCL002@ks.gov AUTHORIZATON FOR
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 002 Individual Background Check.pdf
at least the report source, your name, state, email, relationship to the victim, and a phone
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Reporter’s email address is important to ensure that we can properly address the concern in
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https://www.dcf.ks.gov/services/PPS/Documents/Quick_Guide_to_Online_Reporting.pdf
Kansas Department of Social and
Rehabilitation Services
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Prepared by:
SRS Office of Financial
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Docking State Office Building, 915 S.W. Harrison, Topeka, KS 66612; (785) 296-6217; e-mail
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https://www.dcf.ks.gov/Agency/Documents/SSBG_StatePlan_SFY2012.pdf
The following content was developed by a team of Trainers and Legal Advisors
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: • e-mail • fax • information on the computer • voice • paper The HIPAA Privacy Rule says
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https://www.dcf.ks.gov/Agency/Documents/HIPAA-Training.pdf
Address Apt. # City State Zip Code Telephone E-mail County B. Do you appoint someone other
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Telephone Address Apt. # City State Zip E-mail State of Kansas Social and Rehabilitation
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https://www.dcf.ks.gov/Documents/Food/ES-3100.8_Application_Redetermination_01-06.pdf