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
Prevention and Protection Services- Adult Protective Services
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Service Center: Email Address: Phone
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If you are not the intended
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10370.doc
SOUL Family Legal Permanency shall use this form to send updates to the DCF Regional office at the time changes occur
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Note the following changes and return to the designated office
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6320.doc
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
State Zip: Date Sent to Custodian: Email address: The custodianship subsidy is to be
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Please answer the following questions and return to the designated office within thirty (30
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6165.doc
Part 2 Service and Payment Authorizations
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Rehabilitation Services (RS) must employ methods of
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1. Staff need to call/email to speak with the provider/vendor to let them know and ensure
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https://www.dcf.ks.gov/services/RS/Documents/Policy/SEC_6-2.docx
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