State of Kansas Independent Living PPS 7300
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Department for Children and Families Case Determination REV. Oct. 2019
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Prevention and Protection Services Page 1 of 1
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Email Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7300.docx
Individuals Determined to Have Achieved an Employment Outcome
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The provision of services under the individual's IPE has contributed to the achievement of the employment outcome
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https://www.dcf.ks.gov/services/RS/Documents/Policy/SEC_5-1.docx
Consumer’s work skills, conditions, preferences and interest
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(Recommend other pertinent consumer information be shared with the provider to assist
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Provider Contact Name: Phone: Email
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https://www.dcf.ks.gov/services/RS/Documents/service_descriptions/Contracts/Section 11 Part-24_Service_referral_form.doc
Section 7 Pre-Employment Transition Services (Pre-ETS
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Protection, use, and release of personal
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or Manager receives a call or email regarding a concern from the Client Assistance Program
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https://www.dcf.ks.gov/services/RS/Documents/Policy/SEC_7-14.docx
DCF REGION: SERVICE COUNTY: PROVIDER: REQUESTOR Name (f, mi., l): SSN: Address
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PPS STAFF NAME: DATE: PHONE: EMAIL: PPS SUPERVISOR AUTHORIZATION: Supervisor or
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4007.doc
Telephone # (Cell) City, State Zip: Email address: Permanent Custodians shall use
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Note the following changes and return to the designated office within thirty (30) days of the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6170.doc
Mailing Address (Street, City, State, Zip Code
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Email
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I/We agree to make monthly payments of $ __per month for consecutive months to complete repayment of the debt
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6180.doc
If you are a mandated reporter and have the
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Contact Information:
Reporter telephone number and Email Address (You will receive an Email confirmation message that you can print and
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https://www.dcf.ks.gov/services/PPS/Pages/OnlineReportingInformation.aspx
REPORT/REQUEST FOR SERVICES PPS 1001
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Jul 20 Case Name: Click here to enter text
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Report Date Click here to enter a date
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Email: Employer: Report Source (Relationship) Choose an item
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1001.doc
Child: minor under the age of 18
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Consul/consular officer: foreign government official
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Affairs through http://travel.state.gov/consularnotification or email at consnot@state.gov
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5E.doc