Department for Children and Families Prevention and Protection Services
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Provider’s Name: E-mail: Month: Address where care occurs: Year: List all
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/5828E.docx
Please email this enrollment form along with a copy of your child support order, income
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If yes, how would you like to receive the surveys: ☐Text ☐Email ☐Both, text & email
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https://www.dcf.ks.gov/services/CSS/Documents/CSS Enrollment Form.pdfView duplicates
Prevention and Protection Services PPS CLIENT PURCHASE AGREEMENT
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PPS Worker: Fax: Region: Co: e-mail: @ks.gov Program: Client Information Client
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2833.doc
This agreement is being executed on this date, prior to the finalization of the adoption, for the purpose of adoption assistance and/or medical services for the said child under the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6130.doc
Name of person completing this form
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E-mail address
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Child’s Name: MATCH ID: Facts Client ID
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Is this child a member of a sibling group
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Move child to the private site (child will not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5315.doc
Disability Determination Referral to Kansas Legal Services Child age birth to 17 years Child/Youth – age 18 to 23 years Child’s Name: DCF Case Number: SSN Street Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5U.doc
The Child Care Exception Payment (CCEP) Program is a supplement to Foster Care Child Care (FCCC) funding
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FCCC funding must be used first where applicable
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E-mail of Childcare Provider
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/5258B.docxView duplicates
When DCF is no longer the Representative Payee of a foster child’s benefit, the worker shall
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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.docx
Instructions: The Site Visit Tool is to be completed at in-person site visits for initial reviews, 90-day reviews and annual reviews
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This site visit tool will score the policy and
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_8000_Forms/PPS8400D.doc
Transitional Living Program (TLP) Site Visit Tool
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Instructions: The Site Visit Tool is to be completed at in-person site visits for initial reviews, 90-day reviews and annual reviews
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_8000_Forms/PPS8400E.doc