Contact name/number(s) for family
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CPS Specialist’s Email
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☐ No ☐ Yes (If yes, list name
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Dates/Times CPS Specialist/Family Preservation Liaison is available for Initial Family Meeting
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4200.docx
Address: City/State/Zip Phone #: Email: Vendor Name: Vendor ID: Address: City/State/Zip Phone #: Email
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Subsidy Amount and Month Authorized: Month/Year
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7210.docView duplicates
shall be sent to the DCF NYTD email and DCF Independent Living regional email, where the youth will be located or has
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3059C_Instr.doc
OR DCF/Prevention and Protection Services
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Adult Adoptee/Birth Sibling Requesting Search/Contact
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Return to: Prevention and Protection Services
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Note: This form is to be
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Your email address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0340.docx
Return to: Prevention and Protection Services
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Note: This form is to be used for contact with adult (18+) adoptees, whom adoption finalized in Kansas
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Your Email
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You must be named in the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0335.docx
The PPS 4200 Family Preservation Referral shall be completed for each family referred to the
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CPS Specialist’s Email: Enter the email address where the CPS Specialist can be contacted
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4200_Instr.docx
Waiver and Privacy Agreement
Send an email to DCF.FPTopeka@ks.gov – with the Date of
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completed DCF Required paperwork to the email – (Waiver / FP-1020)
Return to Office of
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https://www.dcf.ks.gov/Agency/Operations/Pages/Fingerprint--Srvices.aspx
The adoption assistance case shall be reviewed on an annual basis
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This review serves as a tool
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City: State: Zip Code: Date Sent: Parent 1 Email address: Parent 2 Email address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6135.docView duplicates
Each regional office has a person(s) assigned to create and maintain provider agreements
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This person is referred to as the Provider Agreement Specialist (PAS
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Email
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https://www.dcf.ks.gov/services/PPS/Documents/FY2025 DataReports/Misc/Provider Agreement - Regional Contacts.docx
Department for Children and Families REV. Jan. 25
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Return to: DCF/Prevention and Protection Services
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Note: This form is to be used by adults (18+) who were
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Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0332.docx