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
If you are a mandated reporter and have the
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Contact Information:
Reporter telephone number and Email Address (You will receive an Email confirmation message that you can print and
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https://www.dcf.ks.gov/services/PPS/Pages/OnlineReportingInformation.aspx
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
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
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
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
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
Prevention and Protection Services- Adult Protective Services
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Service Center: Email Address: Phone
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If you are not the intended
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10370.doc
SOUL Family Legal Permanency shall use this form to send updates to the DCF Regional office at the time changes occur
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Note the following changes and return to the designated office
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6320.doc