Name of person completing this form
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E-mail address
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Child’s Name: MATCH ID: Facts Client ID
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Is this child a member of a sibling group
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Move child to the private site (child will not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5315.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
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
Prevention and Protection Services KIPS Investigation ID: PPS 10600
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to KGP Telephone 785-587-8555 Worker E-mail address Telephone Number I
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Yes No If yes, what is
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10600.doc
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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This site visit tool will score the policy and
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_8000_Forms/PPS8400C.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
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
Adoption Child Profile and Website Registration Match Form
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Check One) Initial Referral Profile Update, CH
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Phone: Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5310.docx