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
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 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.pdf
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
State of Kansas Authorization to Disclose Information Appendix 5Q Department for Children
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orally, in paper documents, or electronically by e-mail, fax machine, or data entry into the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5Q.pdf
FCL 402S DEPARTAMENTO DE NIÑOS Y FAMILIAS DE KANSAS Rev. 02/21 Foster Care Licensing (Licencias para acogida de menores
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PO Box 1424 Topeka, Kansas 66601-1424
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Email
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 402S Family Foster Home Renewal Application in Spanish.pdf
KS 66603 Página web: http://www.dcf.ks.gov Email: DCF.FCL002@ks.gov AUTORIZACIÓN PARA LA
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SW Van Buren Topeka, KS 66603 Página web: http://www.dcf.ks.gov Email: DCF.FCL002@ks.gov
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 002S Individual Background Check in Spanish.pdf
DEPARTAMENTO DE NIÑOS Y FAMILIAS DE KANSAS Foster Care Licensing (Licencias para acogida de menores) PO Box 1424 Topeka, Kansas 66601-1424
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Dirección: Teléfono: Email
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 007S Request for Program Review in Spanish.pdf