Economic and Employment Services IS-4315 Rev. 04-16
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Describe the basis of the consumer’s incapacity/disability and attach copies of any available medical, psychological or psychiatric
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https://content.dcf.ks.gov/EES/KEESM/Forms/Referral to Rehabilitation Services.docxView duplicates
Is there anything from the last visit that’s still a problem
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Is there anything about which I want my worker to know and/or help
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□ I have my workers phone and email information
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3061.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
Prevention and Protection Services PPS 10350
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REV 07/2021 Notification to Law Enforcement
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Please type or print Involved Adult: Name Date Received by
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Adult Protective Specialist Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10350.doc
02-17 INSTRUCTIONS: Complete this form and email to DCF.EBTMAIL@ks.gov within 20 days of
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Retain original in the case file
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TYPE OF ACTIVITY (CHECK ONE) ADD CHANGE DELETE 1. NAME
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-524_FS_Disqualification02-17.docView duplicates
Kansas Department for Children and Families
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What an Application Should Include 8
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Grant Budget Request, Budget Narrative/Justification
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DCF Pre-Award Manager via e-mail at dcf.grants@ks.gov
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https://www.dcf.ks.gov/Agency/Operations/Documents/Old RFP's and RFP Amendments/WFD RFP.docx
Client is being referred to the Workforce Center to register for a KANSASWORKS Plus account and to enroll in Career Ready 101
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Client is scheduled to visit the Workforce Center by
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EMAIL
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-4418_CR101_Referral_Turn_Around_Form_01-21.docView duplicates
Food Assistance Replacement During Household Disasters
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Email: EBTMAIL (DCF.EBTMAIL@ks.gov
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When food purchased with food assistance benefits is destroyed in a disaster (definition below
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3143_fs_disaster_form_08-21.docxView duplicates
Director (name, title, address, telephone, e-mail). Section E: Financial Officer (name, title, address, telephone, e-mail). Section F: Type of application - choose
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https://www.dcf.ks.gov/services/RS/Documents/Mentoring RFP/REVISED_DATES_ RFP_Mentoring_Youth_with_Disabilities_10-6-11_PS.docx
All releases and fees should be sent via postal mail to the attention of: DCF, Child Abuse
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Contact Person: Agency Name: Mailing address: Email Address: Phone Number
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1011.doc