Foster Care and Residential Facility Licensing Division
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An exception to a Regulation may be allowed by DCF if
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Please complete the following and return to Kansas Department
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E-mail Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL-408_DCFExceptionWorksheet.pdf
DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing and Background Checks Division PO BOX
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Child placing Agency Name Telephone Number E-mail Address
https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_656_CPAWithdrawalOfSponsorship.pdf
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
Department for Children and Families REV 10/22/21 Prevention and Protection Services Timesheet Page 1 of 1
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Provider’s Name: E-mail: Month: Address where care occurs: Year
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/5828E.pdf
DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing and Background Checks Division PO BOX 1424
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Signature of CPA Social Worker Telephone Number Fax Number E-mail Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_408_FFHExceptionWorksheet.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
(not needed for Imprest or SinglePay
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above within the first 10 days of each month after services are
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provide 10 working days’ notice if need exists to terminate this agreement early
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2833.pdf
State of Kansas Department for Children and Families Prevention and Protection Services WARDS
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Accountant at bottom of Worksheet and e-mail Worksheet(s) with attachments (if applicable
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5927B_Instr.pdf
State of Kansas Department for Children and Families Prevention and Protection Services CCEP Program Child Care Provider Agreement PPS 5258b REV
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E-mail of Childcare Provider
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https://www.dcf.ks.gov/services/PPS/Documents/FY2022DataReports/Public Website Documents/5258b-CCEPPChild Care Provider Agreement.pdfView duplicates