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Prevention and Protection Services

Appendices and Miscellaneous Forms

​ ​ ​​​​​​
Listing of key staff
Form Number Form Date Form NameFormOther Languages
ADM-346512/2011Invoice and Timesheet Purchase of Service xls  
Appendix 0A
Expanded History Check Letter doc  pdf  
​Appendix 0B​01/2024​Critical Incident Review Staff Interview ​doc  pdf
​Appendix 0C​07/2019​Critical Incident Review Observationsdoc  pdf
​Appendix 0D​01/2025​Initial TDM Protocoldoc  pdf
​Appendix OD1​01/2025​Placement Stability TDM Protocoldoc  pdf
​Appendix 0E​04/2026
​Initial TDM Meeting Scheduling Form doc  pdf​
​Appendix 0F​10/2019​Initial TDM Worker Quick Presentationdoc  pdf
​Appendix OF1​01/2025​PS-TDM Worker Quick Presentation Outline    doc  pdf
​Appendix OF2​01/2025​PS-TDM Supervisor Guide​    doc  pdf
​Appendix OF3​01/2025​TDM Key Elementsdoc  pdf
​Appendix 0G​10/2019​Supervisor Consultation for Initial TDM Meeting ​doc  pdf
​Appendix 0H​10/2019​Supervisor Guide to Initial TDM Meetingdoc  pdf
​Appendix 0I​10/2019​Worker's Guide for an Effective TDM Meetingdoc  pdf
​Appendix 0J​10/2019​Guide for Discussion of Risk and Safety Assessment Initial Removal TDMdoc  pdf
​Appendix 0K​04/2026
​Tips for Supervisors for Effective TDMdoc  pdf
​Appendix 0L​10/2019​Tips for Workers for Effective TDMdoc  pdf
​Appendix 0M​01/2025​Initial TDM Form ​doc  pdfspadoc  spapdf
Appendix 0N​07/2025​Meetings with Familiesdoc  pdf
​Appendix 0P​01/2023​Family Meeting Map ​doc  pdf​
​Appendix 0Q04/2026
​TDM Brochurepdfspapdf
Appendix 0R​07/2025​Family Meeting Brochure ​pdfspapdf​
​Appendix 1A​04/2026
Kansas Intake Guidancedoc  pdf
​Appendix 1B04/2026
​Factors to Consider Before Leaving a Child at Home Alone pdf ​spapdf
​Appendix 1C10/2012​​Child Abuse and Neglect-Protective Services Alert Reportdoc  pdf
​Appendix 1E​07/2021​Adult Protection Services Initial Assessment Guidedoc  pdf
​Appendix 1J01/2023​Disability/Special Needs Table doc  pdf
​Appendix 2A​07/2016​Kansas Statute Annotated- Sexual Abuse Definitionsdoc  pdf
​Appendix 2B07/2025Guide for Assessment and Decisions doc  pdf
Appendix 2E​​01/2025DCF Case Finding History​doc  pdf
Appendix 2F​​07/2013Six Areas of Family Life for Assessment​doc  pdf
​Appendix 2G04/2026
​KIDS Upload Instructionsdoc  pdf
​Appendix 2H​04/2026
​Safety Assessmentdoc  pdf
​Appendix 2I​01/2017​Interview Guide for Runaway and Truant Childrendoc  pdf
​Appendix 2J​01/2017​Caregiver Protective Capacity Factorsdoc  pdf
Appendix 2K​04/2026
​Lasting Safety Tips Sheetdoc  pdf
​Appendix 2L​07/2017​Factors to Guide the Plan of Safe Caredoc  pdf
​Appendix 2N04/2026
​My Three Houses/Three Pages  ​doc  pdf​
spadoc  spapdf
​​Appendix 2N04/2026
​My Three Houses/One Page
doc  pdf
​spapdf​
​Appendix 2O​04/2026
​Fairy Wizard Instructionsdoc  pdf​spadoc  spapdf
​Appendix 2P​04/2026
​Fairy Wizard Templatedoc  pdf
​Appendix 2W​04/2026
​Ecomap Templatedoc  pdf
​Appendix 2Z​07/2021Copying from Microsoft Word into KIDS​doc  pdf
​Appendix 3A​01/2018​Fatherhood Involvement Guide ​doc  pdf
​Appendix 3B​01/2020​Basic Genogram Symbolsdoc  pdf
​Appendix 3C​Ecomap Symbols pdf
​Appendix 3D07/2013​Medical List doc  pdf
​Appendix 3E ​Time Line Example doc  pdf
​Appendix 3F10/2012​​Early Reunification Prognosis Indicatorsdoc  pdf
​Appendix 3G01/2024​Foster Parent Report to the Court doc  pdf spadoc spapdf
​Appendix 3H07/2012​​Case Plan Documentation Checklistdoc  pdf
​Appendix 3I​07/2023​Mental Health Workflowdoc  pdf
​Appendix 3J10/2012​​Child Welfare Mental Health Referral Guide doc  pdf
​Appendix 3JI​07/2025​Screening Tool for Federal Benefitsdoc pdf
​Appendix 3K07/2019​Request for Initial Mental Health Assessment/Transfer of Services ​pdf​​
​Appendix 3L10/2012​​Social Emotional Screening Tooldoc  pdf
​Appendix 3M​01/2025​Family Mobile Crisis Linedoc  pdf ​spadoc  spapdf
Appendix 3N01/2018​​Family Finding Search Websites doc  pdf
​Appendix 3Q10/2012​​Case Review Timelinedoc  pdf
​Appendix 3S 04/2018​​Permanency Staffing Guide doc  pdf
​Appendix 5A​04/2026
​Icebreakers Brochurepdf ​spadoc  spapdf
​Appendix 5B​01/2025
​Non-Licensed Placement​ Crisis Support Information Acknowledgement​
​doc  pdf            spadoc  spapdf
​Appendix 5C​07/2021​Relative Placement Assessmentdoc  pdf
​Appendix 5D​04/2018​Supervisor Consultation Guide ​doc  pdf
​Appendix 5E​01/2013​Consular Notification and Access Fact Sheetdoc  pdf
​Appendix 5F10/2012​Requesting SS Carddoc  pdf
​Appendix 5G04/2026
​Notification to Parent Considering Relinquishmentdoc  pdf
​Appendix 5G104/2026
​Acceptance of Relinquishment of Parental Rightsdoc  pdf
​Appendix 5G2​04/2026
​Refusal of Relinquishment of Parental Rightsdoc​  pdf
​Appendix 5H04/2026
​Consent for Release of Informationdoc  pdf spadoc​ spapdf
​Appendix 5J01/2025​Relinquishment of Minor Child to Agency doc  pdf ​ 
​Appendix 5K 10/2012​​OPPLA CAdoc  pdf spadoc spapdf
​Appendix 5L 04/2026
​Custodianship CAdoc pdf spadoc spapdf
​Appendix 5M​01/2014​Referral to DCF for Continued Servicesdoc  pdf
​Appendix 5O​01/2020​Kansas Foster Parents' Rightsdoc  pdf
​Appendix 5P​07/2019​Educational Stability Process Mapdoc   pdf
​Appendix 5Q01/2023​Authorization to Disclosure Information, Including Child(ren)'s Individual Identifiable Health Information​ ​doc​  pdf spadoc​  spapdf
Appendix 5R​​04/2026
​Checklist for Request for Consent to Adopt doc  pdf
Appendix 5S​04/2026
​Best Interest Staffing for Children in Foster Care Brochuredoc  pdf
Appendix 5T​​04/2026
​Adoption from Foster Care Brochuredoc  pdf
Appendix 5U​04/2026
​Disability Determination Referral to Kansas Legal Servicedoc  pdf
​Appendix 5V04/2026
​Guide to Understanding SSI and the DCF/KLS Contractdoc  pdf
​Appendix 5W04/2026
​Preparing Children for Adoption
doc  pdf
​Appendix 5Y04/2026
​Letter to Parents Considered at a BISdoc  pdf
​Appendix 5Z04/2026
​Normal Phases of Pre-Finalization ​doc  pdf
​Appendix 6A04/2026
​Permanent Custodianship Subsidy Brochure ​doc pdf
​Appendix 6B04/2026
​Adoption Assistance Brochure doc​ pdf
Appendix 6C​04/2026
​Legal Fee Reimbursement for Adoptiondoc  pdfspadoc  spapdf
Appendix 6D​04/2026
​Annual Adoption Assistance Review-Second Notice doc  pdfspadoc  spapdf
Appendix 6E​04/2026
​Adoption Assistance Repayment Agreementdoc  pdf
​Appendix 6F04/2026
​Adoption and Permanent Custodianship Informationdoc  pdf
​Appendix 7A07/2015​​Youth Advisory Council Handbookdoc  pdf
​Appendix 7B10/2012​​Application for KYAC Membershipdoc  pdf
​Appendix 7E
07/2020​Checking and Clearing Credit History for Youthdoc  pdf
Appendix 7F​​01/2015​Certification for Identification Cardpdf
​Appendix 9B01/2026
​ICPC Supervision Report-90 Daysdoc  pdf​
​Appendix 9C10/2012​​ICPC Supervision Report-30 Daysdoc  pdf
Appendix 9D​07/2015​​Interstate Compact on the Placement of Children Articles and Regulationsdoc  pdf
Appendix 9F​​07/2014​ICPC Medial Card Processxls   pdf
Appendix 9G​​07/2013​Sample Reg 7 Court Orderdoc  pdf
Appendix 9H​​07/2014​ICPC Referral Checklistdoc  pdf
​Appendix 9I​07/2016​Interstate Compact on Adoption and Medical Assistancedoc  pdf
Appendix 10A​​07/2023​Adult Protective Services Statutesdoc  pdf
​Appendix 10B​07/2016​APS Guidelines to consider when making a findingdoc  pdf
​Appendix 10C​7/2021​Records to Obtain During Investigationdoc  pdf
​EP Appendix A​​​Kansas AFDC Needs Standards doc  pdf ​ 
​​EP Appendix D
08/2016​Computer Systems-WARDS Users Handbookdoc  pdf
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