Page 1 of 19 FCL 403
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of Applicant/Licensee (exactly as it appears on the license) Telephone Number Email Address
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Surveyor’s Signature Agency Represented Email Address Date
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 403 FFH Survey Instrument-CPA.pdfView duplicates
DOB APPROVAL STAMP (If Required) Revised 05/03/2022
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Department for Children and Families Rebecca Gerhardt 785-296-3825
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Agency Agency Contact Contact Phone Number
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https://www.dcf.ks.gov/Newsroom/Documents/Economic_Impact_Statement-Rules_and_Regulations-JCIC 9-22-2023.pdf
Kansas Department of Social and
Rehabilitation Services
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Prepared by:
SRS Office of Financial
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Docking State Office Building, 915 S.W. Harrison, Topeka, KS 66612; (785) 296-6217; e-mail
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https://www.dcf.ks.gov/Agency/Documents/SSBG_StatePlan_SFY2012.pdf
Kansas Family Mobile Crisis Response successfully launched
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Services are available for all Kansans 20 years old or younger, including anyone in foster care or formerly in foster care
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https://www.dcf.ks.gov/services/PPS/Documents/FY2022DataReports/Family First/Aug_Sept_Oct2021_ Prevention in Kansas.pdf
(Donor must have picture ID to show to collection site personnel
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Type of Test to Be Conducted: Drug Test (NIDA/5) Panel
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Normal Collection - H39 Screen 5, PCP
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852-5201 or email
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https://content.dcf.ks.gov/ees/KEESM/Forms/ES-4108_Collection_Site_Passport.pdfView duplicates
The Kansas Department for Children and Families (DCF) works with approximately 750 youth from
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please call 785-296-3944 or send an email to dcf.H4H@ks.gov. Wrapped gifts and gift cards
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https://www.dcf.ks.gov/services/PPS/Documents/HopeForTheHolidays.pdf
STUDENT EMAIL ADDRESS EXPECTED DATE TO COMPLETE OR EXIT HIGHSCHOOL CURRENT GRADE LEVEL OF
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IF NO, DO YOU HAVE AN
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PARENT, GUARDIAN, REPRESENTATIVE PHONE CELL PHONE EMAIL ADDRESS 4/2/2019
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https://www.dcf.ks.gov/services/RS/Documents/RS Forms/Pre-ETS_Request_2.pdf
Address Apt. # City State Zip Code Telephone E-mail County B. Do you appoint someone other
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Telephone Address Apt. # City State Zip E-mail State of Kansas Social and Rehabilitation
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https://www.dcf.ks.gov/Documents/Food/ES-3100.8_Application_Redetermination_01-06.pdf
Chapter 2: Family Foster Home Descriptions
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Levels of Service (Level of Care/LOC
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Intensive Family Foster Home (Intensive 1 & Intensive 2
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HCBS Waiver Family Foster Home (HCBS – I/DD
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https://www.dcf.ks.gov/services/PPS/Documents/FY2022DataReports/MiscWebPostings/Placement_Standards_August_2022.pdf
you are testifying via WEBEX, be sure your email is provided in this cover letter so I can email the link to you prior to the meeting
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https://www.dcf.ks.gov/Agency/Testimony/Documents/2023/HB 2021 DCF Written Only.pdf