UNIVERSAL PACKET SERVICE ENTRY AUTHORIZATIONS Client Name
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_ Initial when applicable Authorization Explanation Exceptions of By signing below and initialing, the client
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E-mail Address
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https://www.dcf.ks.gov/services/PPS/Documents/FY2025 DataReports/Misc/2025 kdads-universal-packet-fillable-form 3.5.2025 final accessible.pdf
If it is in fact an
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to the Family First Grantee (Provider) (shown in the box below by region), Regional Family First Email Inbox (shown in Section 1), and the Region’s FACTS Email Inbox
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4311_Instr.pdf
☐ African ☐ American Indian/Alaska Native ☐ Asian ☐ Black/African American
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Caregiver Email
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Case Manager Email
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Primary Physician Email
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https://www.dcf.ks.gov/services/PPS/Documents/SE Resources/BI_Program_Referral.pdf
Appendix 0E Department for Children and
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The TDM Scheduler will invite professionals if email address is available
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Phone number/email address
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For scheduling, email the completed form to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_0E.pdf
NOTICE TO PARENT: This is an important legal document and by signing it you are permanently giving up all custody and other parental rights to the child named herein
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5J.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Referral for QRTP Assessment For Child
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Email Address
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Once this form is complete please email to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5115.pdf
DEPARTMENT FOR CHILDREN AND FAMILIES - ECONOMIC AND EMPLOYMENT SERVICES POLICIES AND PROCEDURES
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exchange of Federal Tax Information via both e-mail and facsimile are strictly prohibited
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https://content.dcf.ks.gov/EES/KEESM/Appendix/X-7_safeguard_2018.pdfView duplicates
State of Kansas PPS 3059B Department for Children and Families
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Phone/Email
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Family Waiver Care: 785-296-9551 or email tawaiver@family-waiver-care.com
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3059B.pdf
LOW INCOME ENERGY ASSISTANCE PROGRAM (LIEAP) 8-24-A
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How can you apply for LIEAP
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Log In to the online portal to begin
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You can return it to us
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By email
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By fax To find your local DCF office
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https://content.dcf.ks.gov/ees/KEESM/Forms/ES-3500LIEAPApplication11.23.pdfView duplicates
your additional correspondence recipient address and point of contact name, phone, and email
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Program Name: KEHS- Address: City: State: Zip: Contact Name: Phone: Email
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https://content.dcf.ks.gov/ees/KEESM/Forms/ES-1610-KansasEarlyHeadStartChildCarePartnershipsReferralForChildCareAssistance.pdfView duplicates