Kansas Department of Social and
Rehabilitation Services
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Prepared by:
SRS Office of Financial
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Docking State Office Building, 915 S.W. Harrison, Topeka, KS 66612; (785) 296-6217; e-mail
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https://www.dcf.ks.gov/Agency/Documents/SSBG_StatePlan_SFY2012.pdf
(Donor must have picture ID to show to collection site personnel
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Type of Test to Be Conducted: Drug Test (NIDA/5) Panel
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Normal Collection - H39 Screen 5, PCP
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852-5201 or email
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https://content.dcf.ks.gov/ees/KEESM/Forms/ES-4108_Collection_Site_Passport.pdfView duplicates
Send a scan of the form to the EBT Unit as an attachment to an e-mail to DCF.EBTMAIL@ks.gov
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portions of the form are completed, email the completed form to the Administrative Office
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3142EBT_Ben_Repay05-22.pdfView duplicates
State of Kansas Department for Children and Families Prevention and Protection Services PPS 3059 Instructions REV. July 2022 Page 1 of 5 My Plan for Successful Adulthood
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3059_Instr.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Appendix 9D July 2015
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Conversion of Intrastate Placement into Interstate Placement; Relocation
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_9D.pdf
FCL 656 Rev. 03/23 KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing PO Box 1424 Topeka, Kansas 66601-1424 500 SW Van Buren Street 2 nd Floor Topeka
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Email Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL 656 CPA Withdrawal of Sponsorship.pdf
The Kansas Department for Children and Families (DCF) works with approximately 750 youth from
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please call 785-296-3944 or send an email to dcf.H4H@ks.gov. Wrapped gifts and gift cards
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https://www.dcf.ks.gov/services/PPS/Documents/HopeForTheHolidays.pdf
Address Apt. # City State Zip Code Telephone E-mail County B. Do you appoint someone other
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Telephone Address Apt. # City State Zip E-mail State of Kansas Social and Rehabilitation
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https://www.dcf.ks.gov/Documents/Food/ES-3100.8_Application_Redetermination_01-06.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
you are testifying via WEBEX, be sure your email is provided in this cover letter so I can email the link to you prior to the meeting
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https://www.dcf.ks.gov/Agency/Testimony/Documents/2023/HB 2021 DCF Written Only.pdf