Disability Determination Referral to Kansas Legal Services Child age birth to 17 years Child/Youth – age 18 to 23 years Child’s Name: DCF Case Number: SSN Street Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5U.doc
STATE OF KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
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*Type Contact: HI (Home Interview); OI (Office Interview); SI (School
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1010.doc
Referral PPS Specialist DCF Worker DCF E-mail address Email Child Welfare (CW) Agency CW Agency CW Case Manager (CM)Worker DCF Phone Phone # CM Email_Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10600B.doc
Transitional Living Program (TLP) 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/PPS8400E.doc
Youth Residential Center II (YRCII) 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/PPS8400G.doc
State of Kansas PPS 5927A Instructions
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Department for Children and Families Rev. October 2019
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Accountant at bottom of Worksheet and e-mail Worksheet with attachments (if applicable) to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5927A_Instr.docx
Checkboxes – Completed by DCF Check the boxes
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Use the email subject line: FF_county abbreviation_Lastname_Firstname_4310_Closure Document
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FACTS email inbox
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Family First email inbox
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4310_Instr.doc
Cell Phone: Email Address
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How many people live in your household
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Are you responsible for caring for a disabled person daily
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Do you have minor children who are temporarily out
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https://content.dcf.ks.gov/EES/KEESM/Appendix/E-6FAETSelfAssessment06-19.docxView duplicates
Question 1: The RFP states that persons eligible for OIB services "are individuals who are age 55 or older whose significant visual impairments make
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Email: Brie.Wilkins@dcf.ks.gov
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https://www.dcf.ks.gov/services/RS/Documents/OIB_QA_10-3-12.docx
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