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
Income of the child (include all income and the source
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Note: Reference Sections 6112C and 6113 in the PPS PPM
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Please attach statement from family as to why they wish to pursue
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6150.doc
Attention Referral Agency: The Kansas Department for Children and Families (DCF) is providing this referral in accordance with K.S.A. 38 2290
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Per K.S.A. 38-2290, upon DCF's receipt
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EMAIL
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2014_B.docx
Body of the email should say: “Please see attached documents concerning the successful
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Send to AG’s office using email address (ANE@AG.ks.gov
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10250_Instr.docx
Request for Information (RFI) Overview 6
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Appendix A - Business Process Workflow 9
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Appendix B - High level Business Requirements 9
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DCF is comprised of Economic and Employment Services (EES
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https://www.dcf.ks.gov/Agency/Operations/Documents/PPS Case Review RFI.docx
Include a copy of your childcare contract or an e-mail from your provider of their rates
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Include copy of cashed checks, receipts, or e-mail from childcare provider
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https://www.dcf.ks.gov/services/PPS/Documents/FY2025 DataReports/Misc/CCEPP Application.docx
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
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
Last Name First Middle Date of Birth / / Maiden name or other names known by Social Security Number
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(PLACE YOUR INITIALS TO THE LEFT OF EACH ITEM APPROVED
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Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0100.doc
The Department for Children and Families (DCF) has received a report of abuse or neglect of a child which is being reported to your agency in accordance with K.S.A.
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Email Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1003.docx