Prevention and Protection Services KIPS Investigation ID
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Worker Name Telephone 785-587-8555 Email Address Email Telephone Number Telephone Numbers I
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Sec. No: SSN Birth Date: DOB
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10600A.doc
Introduction and Purpose of the RFI 5
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Exempt From Disclosure (Protected, Confidential, or Proprietary) 8
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Appendix A – High Level Process Flow Attached
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DCF RS is seeking a commercial off
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https://www.dcf.ks.gov/Agency/Operations/Documents/RS RFI.DOC
Your Current Name: Your Telephone: Your Street Address: Your City/State/Zip: Your
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your identifying information (name, address, email address and/or telephone numbers), do not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0330.doc
Department for Children and Families IS-4315
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Email: Gender
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TANF $ per month Medical SSI
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Child Care Plan in Place SSDI $ per month
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CN Email
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https://content.dcf.ks.gov/EES/KEESM/Forms/IS-4315EmploymentServicesReferraltoVocationalRehabilitation08-21.docxView duplicates
Mother’s right’s terminated/relinquished? Yes No Father’s right’s terminated/relinquished? Yes No
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Anticipated date of child’s high school graduation
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6155.doc
Your Current Name: Your Telephone: Your Street Address: Your City/State/Zip: Birth
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your identifying information (name, address, email address and/or telephone numbers), do not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0335.doc
Pre-ETS Email and Phone Number
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Student’s email
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Parent/Guardian’s email
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Student’s accommodations/auxiliary aid needs or food allergies if applicable
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If you do not accept the referral the
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https://www.dcf.ks.gov/services/RS/Documents/service_descriptions/EmpowerME_referral2.docx
State of Kansas Aftercare Contact Agreement for Young Adults PPS 3070A
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Department for Children and Families (For Cases Where Young Adult is not in the Custody of the Secretary
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Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3070A.docx
☐ Attach and email all forms to the grantee/provider, regional Family First mailbox and your
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Use the email subject line: FF_county abbreviation_Lastname_Firstname_4310_Closure
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS4310.docx
(if different from above): Father’s name
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Name: Address: Phone Number: E-Mail Address: Section VI: Additional Information
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(Email to DCF 30 days prior to the end of aftercare
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5M.doc