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
this client (codes at end of inst) e-mail: enter case worker’s DCF e-mail address Program: select: (Program code for
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2833_instr.doc
A. Social Security Benefits: Yes No If yes, amount
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Anticipated date of youth’s high school graduation
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PPS Administration Use Only for Approval
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6301.doc
Prevention and Protection Services PPS CLIENT PURCHASE AGREEMENT
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PPS Worker: Fax: Region: Co: e-mail: @ks.gov Program: Client Information Client
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2833.doc
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
Community Integration Program (CIP) 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/PPS8400A.doc
Introduction and purpose of the RFI 3
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How to deliver the answer 6
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Marking Records Exempt From Disclosure (Protected, Confidential, or Proprietary) 7
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There is a need for partnerships
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https://www.dcf.ks.gov/Agency/Operations/Documents/Old RFP's and RFP Amendments/Families First Prevention Request for Information.doc
Department for Children and Families REV 07/2021
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Phone Number and Email for APS Specialist
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We received the attached APS report that a criminal act has occurred or
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Officer Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10120_A.docx
Department for Children and Families Beth Lange 296-3967
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Agency Agency Contact Contact Phone Number
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Is/Are the proposed rule(s) and regulation(s) mandated by the federal government as
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https://www.dcf.ks.gov/services/PPS/Documents/Economic_Impact_Statement.docx
Agency mailing address Agency email address Check box if agency is a
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(Please allow 3-5 days for processing email requests and an additional 5-7 days if returning
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10400.doc