State of Kansas Independent Living PPS 7300
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Department for Children and Families Case Determination REV. Oct. 2019
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Prevention and Protection Services Page 1 of 1
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Email Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7300.docx
Referral for Permanent Custodianship Subsidy Checklist
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This checklist guides the CWCMP through referring a family to receive
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Case Management Provider Contact Agency: Name: Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6149.docx
Provider: Assigned Provider Staff: Phone: Email: Date Aftercare started: Agreement in
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Frequency and method of contacts between case manager and child/family
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3070.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
Individuals Determined to Have Achieved an Employment Outcome
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The provision of services under the individual's IPE has contributed to the achievement of the employment outcome
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https://www.dcf.ks.gov/services/RS/Documents/Policy/SEC_5-1.docx
Section 7 Pre-Employment Transition Services (Pre-ETS
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Protection, use, and release of personal
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or Manager receives a call or email regarding a concern from the Client Assistance Program
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https://www.dcf.ks.gov/services/RS/Documents/Policy/SEC_7-14.docx
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
form to DCF youth programs via email, mail, fax (785-296-4685), or in-person delivery
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not have access to a printer, please email DCF.AdminIL@ks.gov and a copy will be mailed with
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https://www.dcf.ks.gov/Newsroom/Pages/Kansas-DCF-Extends-Deadline-for-Pandemic-Relief-Program.aspx
DCF REGION: SERVICE COUNTY: PROVIDER: REQUESTOR Name (f, mi., l): SSN: Address
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PPS STAFF NAME: DATE: PHONE: EMAIL: PPS SUPERVISOR AUTHORIZATION: Supervisor or
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4007.doc
Telephone # (Cell) City, State Zip: Email address: Permanent Custodians shall use
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Note the following changes and return to the designated office within thirty (30) days of the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6170.doc