Provider: Assigned Provider Staff: Phone: Email: Date Aftercare started: Agreement in
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Frequency and method of contacts between case manager and child/family
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3070.doc
Identifying Information: Name of Parent 1: Email Address: Cell Phone #: Name of Parent 2: Email Address: Cell Phone #: Street Address: City
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How did they deal with ended
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5318.doc
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
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 your child is attending school virtually either full or part-time for the 2020-2021 school year
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EES Email
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Save and attach to an email to the office serving the county where you live
https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/Instructions for Submitting Child 2020 School Schedule Form.docxView 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.docView duplicates
with a 10 day time limit
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Phone Call/text/e-mail to reschedule appointment or assignment: check the box if the CN attempted to call/text/e-mail the client and the date of the attempt
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https://content.dcf.ks.gov/EES/KEESM/Appendix/E-5PenaltyChecklistForCN03-19.docxView duplicates
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