Kansas 66603 Fax (785) 296-8609 ● Email: DCF.FCL002@ks.gov ● Website: http://www.dcf.ks.gov
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INDIVIDUAL BACKGROUND CHECK REQUEST FOR LICENSED FACILITIES
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One form is required for each
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_002_Individual_Background_Check_Request.pdf
Kansas Department for Children and Families Backgrounds Division PO Box 1424 Topeka, KS 66601-1424 Fax: (785) 296-8609 DCF.FPTopeka@ks.gov 12/21
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Email
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By signing below, I/We am/are
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https://www.dcf.ks.gov/Agency/Operations/Documents/OBI/Fingerprint_Results-Release_of_Information.pdf
: • Locating information • Establishing or enforcement of an order • Modifying a child support amount • Reporting new information • Learning more about the Family Violence Indicator
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https://www.dcf.ks.gov/services/CSS/Documents/CSS5000 final 1.17.2019 v2.0.pdf
Nationwide List of Child Abuse/Neglect Registry Links
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California does not do out of state
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of Child & Family Services Form If no response after 15 business days, please EMail DCFS
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Nationwide CAN Links PDF.pdf
Is Vocational Rehabilitation the right program for you
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• VR serves people with any type of
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EMAIL ADDRESS CONTACT PERSON’S NAME AND PHONE NUMBER (someone who would be able to give you
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https://www.dcf.ks.gov/services/RS/Documents/RS Forms/VR Application_PDF.pdf
Email: jalbert@mchks.com
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Email: erna.schmidtberger@haysmed.com
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Email: suicor@hhf.ks.org
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Email: carol.schopf@mercy.med
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Email: collection@ohscompare.com
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Email: rcradic@saint.lukes.org
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https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/collection-site-address-list 7-1-14.pdfView duplicates
State of Kansas Department for Children and Families Prevention and Protection Services Monthly Individual Contact Developed by KS Youth
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□ I have my workers phone and email information
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3061.pdf
T A N Y A K E Y S , D E P U T Y S E C R E T A R Y
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J O I N T C O M M I T T E E O N C H I L D W E L F A R E
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Within 2 hours: Case Management Agency email to statewide special response team
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https://www.dcf.ks.gov/Agency/Testimony/Documents/2021/JC CWOS Missing Children and Failure to Place, Dep Sec Keys, DCF.pdf
Date of Birth: Cell Phone: ( ) E-mail: Cell Phone: ( ) E-mail: Race/Ethnicity: (check all that apply
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5320.pdf
The contents of the PPS Policy and Procedure Manual include: A. Policies which define required or prohibited actions
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Policies may contain the following language: 1. Statements
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Policy_and_Procedure_Manual_January2024.pdfView duplicates