Kansas Open Records Act K.S.A. 45-215 et seq. REQUEST FORM
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I hereby certify that I will not
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(A) use any list of names or addresses contained in or derived from the records or information
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https://www.dcf.ks.gov/Records/Documents/KansasOpenRecordsAct_RequestForm.pdf
Kansas Department for Children and Families
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Table of Contents Introduction 2 Chapter 1: Family Foster Home Descriptions 3 Chapter 2: All Family Foster Homes 9 Chapter 3: Intensive
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https://www.dcf.ks.gov/services/PPS/Documents/FY2025 DataReports/Misc/PlacementStandards.pdf
identifiable such as your name, e-mail address, and other non-public information, and
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It is up to you to
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You agree that any such comments and any email we receive becomes our property
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https://www.dcf.ks.gov/Newsroom/Documents/DCFMobileCommunicationsPrivacyPolicy.pdf
Return to: Prevention and Protection Services 555 S. Kansas Ave 4 th Floor Topeka, KS 66603 (785) 296-4653 Authorization To Release Information Form PPS 0350 REV
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Your email address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0350.pdf
UNIVERSAL PACKET SERVICE ENTRY AUTHORIZATIONS Client Name
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_ Initial when applicable Authorization Explanation Exceptions of By signing below and initialing, the client
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E-mail Address
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https://www.dcf.ks.gov/services/PPS/Documents/FY2025 DataReports/Misc/2025 kdads-universal-packet-fillable-form 3.5.2025 final accessible.pdf
NOTICE TO PARENT: This is an important legal document and by signing it you are permanently giving up all custody and other parental rights to the child named herein
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5J.pdf
☐ African ☐ American Indian/Alaska Native ☐ Asian ☐ Black/African American
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Caregiver Email
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Case Manager Email
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Primary Physician Email
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https://www.dcf.ks.gov/services/PPS/Documents/SE Resources/BI_Program_Referral.pdf
If it is in fact an
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to the Family First Grantee (Provider) (shown in the box below by region), Regional Family First Email Inbox (shown in Section 1), and the Region’s FACTS Email Inbox
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4311_Instr.pdf
Appendix 0E Department for Children and
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The TDM Scheduler will invite professionals if email address is available
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Phone number/email address
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For scheduling, email the completed form to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_0E.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Referral for QRTP Assessment For Child
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Email Address
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Once this form is complete please email to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5115.pdf