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
Non-KORA Agency Records Request Form * REQUESTOR INFORMATION
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Requestor Work Email
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Please provide the following information on the person whose Kansas DCF case history is being
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https://www.dcf.ks.gov/Records/Documents/Non-KORA-Agency-RecordsRequestForm.pdf
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/PPS8400C.docView duplicates
Youth Residential Center II (YRCII) 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/PPS8400G.doc
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/PPS8400F.doc
Child Care Providers: The Child Care Exception Payment (CCEP) Program is a supplement to Foster Care Child Care (FCCC) funding
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You must initial each box on
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E-mail of Childcare Provider
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https://www.dcf.ks.gov/services/PPS/Documents/FY2023DataReports/Public Website Documents/5258b_CCEPP CCProvAgreement.docx
Prevention and Protection Services KIPS Investigation ID: PPS 10600
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to KGP Telephone 785-587-8555 Worker E-mail address Telephone Number I
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Yes No If yes, what is
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10600.doc