Email
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B. Type of Agency ☐Public ☐Private Non-Profit ☐Private Profit
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C. Official Authorized to Sign Application
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F. Type of Application ☐New ☐Revision ☐Continuation of Grant
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https://www.dcf.ks.gov/services/RS/Documents/OIB_AttachmentA.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Permanent Custodianship Annual Report PPS 6165 Rev. 01/14 Page 1 of
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Email address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6165.pdf
Standard Language For Grants And Contracts Where Protected Health Information Will Be Exchanged
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(Steps 1-5 may be completed by the
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Work phone, home phone, fax and e-mail of the vendor
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https://www.dcf.ks.gov/services/RS/Documents/Provider_Agreement_Packet_0513_BG.pdf
Student Email Address Expected Date to complete or Exit School Current Grade level of
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Cellphone Email Address
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https://www.dcf.ks.gov/services/RS/Documents/RS Forms/Request_Verification fillable.pdf
Chapter 2: Family Foster Home Descriptions
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Levels of Service (Level of Care/LOC
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HCBS Waiver Family Foster Home (HCBS – I/DD
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Chapter 3: All Family Foster Homes
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https://www.dcf.ks.gov/services/PPS/Documents/CWHandbookofServices/placementservicestandardsmanual.pdf
TITLE IV-B CHILD AND FAMILY SERVICES PLAN
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U.S. Department of Health and Human Services
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This Child and Family Services Plan (CFSP) is the report for the five-year time period Fiscal Year
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https://www.dcf.ks.gov/services/PPS/Documents/Other/TitleIVBStatePlan.pdf
FP-1020 10/21 Page 1 of 1
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Kansas Department for Children and Families
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Instructions: *REQUIRED FIELDS Please Fill in ALL Lines on this Form
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*Have You ever been fingerprinted for DCF
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FP-1020 With Waiver.pdf
Child and Family Services Reviews Program Improvement Plan Kansas
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Submitted To: U.S. Department of Health and Human Services April 3, 2024 555 S Kansas Ave, 1 st Floor Topeka
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https://www.dcf.ks.gov/services/PPS/Documents/CFSR/Kansas R4 PIP Approved Plan.pdf
FAMILY FIRST SERVICE MENU NORTHEAST & SOUTHEAST REGIONS AVAILABILITY* PROGRAM Statewide
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Great Circle: Northeast; Brown, Doniphan, Jackson, Marshall, Nemaha, Pottawatomie, Wabaunsee
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https://www.dcf.ks.gov/services/PPS/Documents/FY2021DataReports/Famiy First/Service Menu Northeast Southeast.pdf
Attachment 4.11(a): Comprehensive statewide needs
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Numerous activities contribute to the ongoing assessment of the rehabilitation needs of Kansans with disabilities
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https://www.dcf.ks.gov/services/RS/Documents/State Plan 2014-2016/4 11(a)_CSNA.pdf