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
Chapter 2: Family Foster Home Descriptions
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Levels of Service (Level of Care/LOC
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Intensive Family Foster Home (Intensive 1 & Intensive 2
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HCBS Waiver Family Foster Home (HCBS – I/DD
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https://www.dcf.ks.gov/services/PPS/Documents/FY2022DataReports/MiscWebPostings/Placement_Standards_August_2022.pdf
State of Kansas PPS 8400D Department for Children and Families REV. 1/2023 Prevention and Protection Services Page 1 of 18
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Instructions: The Site Visit Tool is to be completed at
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_8000_Forms/PPS8400D.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
State of Kansas Department for Children and Families Prevention and Protection Services Initial Eligibility Determination
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If the child is school age
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E-mail address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5410A.pdf
“Family foster home” means a child care facility that is a private residence, including any adjacent grounds, in which a licensee provides care for 24 hours a day for one or more
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FC_Regs_familyfosterhome/Regulations_for_Family_Foster_Homes_for_Children.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
FCL 001S DEPARTAMENTO DE NIÑOS Y FAMILIAS DE KANSAS 02/21 Foster Care Licensing (Licencias
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Dirección del centro: Calle, Ciudad, Estado Email del centro Sección 2. Detalles del plan
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 001S Compliance Action Plan in Spanish.pdf