Name of person completing this form
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E-mail address
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Please mark the box for the action to be taken on the family
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(If changes to composition (i.e. marriage, divorce, birth of a child, ect
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5325.doc
On page 4 regarding accreditation, may a grantee applicant be in the process of obtaining accreditation
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As long as accreditation is approved by award negotiations
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All of the above may be
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https://www.dcf.ks.gov/Agency/Operations/Documents/Old RFP's and RFP Amendments/Family Preservation RFP Questions Answers.docx
All releases and fees should be sent via postal mail to the attention of: DCF, Child Abuse
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Contact Person: Agency Name: Mailing address: Email Address: Phone Number
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1011.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
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
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
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
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
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