Appendices and Miscellaneous Forms



Form Number Form Date Form Name Form Other Languages
ADM-3465 12/2011 Invoice and Timesheet Purchase of Service xls  
Appendix 0A   Expanded History Check Letter doc  pdf  
​Appendix 0B ​07/2019 ​Critical Incident Review Staff Interview ​doc  pdf
​Appendix 0C ​07/2019 ​Critical Incident Review Observations doc  pdf
​Appendix 0D ​10/2019 ​TDM Protocol doc  pdf
​Appendix 0E ​10/2019 ​TDM Meeting Scheduling Form        pdf
​Appendix 0F ​10/2019 ​Worker QUICK Presentation Outline doc  pdf
​Appendix 0G ​10/2019 ​Supervisor Consultation for Initial TDM Meeting ​doc  pdf
​Appendix 0H ​10/2019 ​Supervisor Guide to Initial TDM Meeting doc  pdf
​Appendix 0I ​10/2019 ​Worker's Guide for an Effective TDM Meeting doc  pdf
​Appendix 0J ​10/2019 ​Guide for Discussion of Risk and Safety Assessment Initial Removal TDM doc  pdf
​Appendix 0K ​10/2019 ​Tips for Supervisors for Effective TDM doc  pdf
​Appendix 0L ​10/2019 ​Tips for Workers for Effective TDM doc  pdf
​Appendix 0M ​07/2020 doc  pdf
​Appendix 1A ​01/2020 ​SDM Intake Assessment Policy and Procedures Manual doc  pdf
​Appendix 1B 10/2012​ ​Factors to Consider Before Leaving a Child at Home Alone doc  pdf
​Appendix 1C 10/2012​ ​Child Abuse and Neglect-Protective Services Alert Report doc  pdf
​Appendix 1D ​10/2018 ​Intake Interview Questions Guide doc  pdf
​Appendix 1E ​01/2021 ​Adult Protection Services Initial Assessment Guide doc  pdf
​Appendix 1J 10/2012​ ​Disability/Special Needs Table doc  pdf
​Appendix 2A ​07/2016 ​Kansas Statute Annotated- Sexual Abuse Definitions doc  pdf
​Appendix 2B 01/2021 Guide for Assessment and Decisions doc  pdf
Appendix 2E​ ​01/2020 DCF Case Finding History​ doc  pdf
Appendix 2F​ ​07/2013 Six Areas of Family Life for Assessment​ doc  pdf
​Appendix 2G ​07/2016 ​KIDS Upload Instructions doc  pdf
​Appendix 2H ​01/2021 ​Safety Assessment doc  pdf
​Appendix 2I ​01/2017 ​Interview Guide for Runaway and Truant Children doc  pdf
​Appendix 2J ​01/2017 ​Caregiver Protective Capacity Factors doc  pdf
Appendix 2K ​01/2021 ​Lasting Safety Tips Sheet doc  pdf
​Appendix 2L ​07/2017 ​Factors to Guide the Plan of Safe Care doc  pdf
​Appendix 2N ​01/2021 ​My Three Houses doc  pdf doc  pdf
​Appendix 2O ​01/2021 ​Fairy Wizard Instructions doc  pdf doc  pdf
​Appendix 2P ​01/2020 ​Fairy Wizard Template doc  pdf
​Appendix 2W ​01/2020 ​Ecomap Template doc  pdf
​Appendix 2Y ​01/2021 ​Crosswalk Signs of Safety Practice doc  pdf
​Appendix 3A ​01/2018 ​Fatherhood Involvement Guide ​doc  pdf
​Appendix 3B ​01/2020 ​Basic Genogram Symbols doc  pdf
​Appendix 3C ​Ecomap Symbols pdf
​Appendix 3D 07/2013 ​Medical List doc  pdf
​Appendix 3E ​Time Line Example doc  pdf
​Appendix 3F 10/2012​ ​Early Reunification Prognosis Indicators doc  pdf
​Appendix 3G 01/2018​ ​Foster Parent Report to the Court doc  pdf spadoc spapdf
​Appendix 3H 07/2012​ ​Case Plan Documentation Checklist doc  pdf
​Appendix 3J 10/2012​ ​Child Welfare Mental Health Referral Guide doc  pdf
​Appendix 3K 07/2019 ​Request for Initial Mental Health Assessment/Transfer of Services pdf
​Appendix 3L 10/2012​ ​Social Emotional Screening Tool doc  pdf
Appendix 3N 01/2018​ ​Family Finding Search Websites doc  pdf
​Appendix 3Q 10/2012​ ​Case Review Timeline doc  pdf
​Appendix 3R 01/2016​ ​Change of Venue doc  pdf
​Appendix 3S 04/2018​ ​Permanency Staffing Guide doc  pdf
​Appendix 5A ​07/2020 ​Icebreakers Brochure pdf ​doc  pdf
​Appendix 5C ​01/2021 ​Relative Placement Assessment doc  pdf
​Appendix 5D ​04/2018 ​Supervisor Consultation Guide ​doc  pdf
​Appendix 5E ​01/2013 ​Consular Notification and Access Fact Sheet doc  pdf
​Appendix 5F 10/2012​ Requesting SS Card doc  pdf
​Appendix 5G 01/2021 ​Notification to Parent Considering Relinquishment doc  pdf
​Appendix 5G1 ​01/2021 ​Acceptance of Relinquishment of Parental Rights doc  pdf
​Appendix 5G2 ​01/2021 ​Refusal of Relinquishment of Parental Rights ​doc  pdf
​Appendix 5H 01/2017​ ​Consent for Release of Information doc  pdf spadoc spapdf
​Appendix 5I 07/2019 ​Guide for Sibling Split Request doc  pdf 
​Appendix 5J 01/2019​ ​Relinquishment of Minor Child to Agency doc  pdf ​ 
​Appendix 5K 10/2012​ ​OPPLA CA doc  pdf spadoc spapdf
​Appendix 5L 10/2012​ ​Custodianship CA doc pdf spadoc spapdf
​Appendix 5M ​01/2014 ​Referral to DCF for Continued Services doc  pdf
​Appendix 5O ​01/2020 ​Kansas Foster Parents' Rights doc  pdf
​Appendix 5P ​07/2019 ​Educational Stability Process Map doc   pdf
​Appendix 5Q 07/2015​ Authorization to Disclosure Information, Including Child(ren)'s Individual Identifiable Health Information​ doc  pdf spadoc  spapdf
Appendix 5R​ ​07/2019 ​Checklist for Request for Consent to Adopt  doc  pdf
Appendix 5S​ ​01/2019 ​Best Interest Staffing for Children in Foster Care Brochure doc  pdf
Appendix 5T​ ​01/2017 ​Adoption from Foster Care Brochure doc  pdf
Appendix 5U​ ​07/2014 ​Disability Determination Referral to Kansas Legal Service doc  pdf
​Appendix 5V ​07/2014 ​Guide to Understanding SSI and the DCF/KLS Contract doc  pdf
​Appendix 5W ​01/2017 ​Preparing Children for Adoption doc  pdf
​Appendix 5X ​07/2017 ​Sibling Connections ​doc  pdf
​Appendix 5Y ​07/2019 ​Letter to Parents Considered at a BIS doc  pdf
​Appendix 5Z ​07/2018 ​Normal Phases of Pre-Finalization ​doc  pdf
​Appendix 6A 07/2016​ ​Permanent Custodianship Subsidy Brochure pdf
​Appendix 6B 01/2014​ ​Adoption Assistance Brochure pdf
Appendix 6C​ 07/2019 ​Legal Fee Reimbursement for Adoption doc  pdf spadoc  spapdf
Appendix 6D​ 02/2018 ​Annual Adoption Assistance Review-Second Notice doc  pdf spadoc  spapdf
Appendix 6E​ ​07/2017 ​Adoption Assistance Repayment Agreement doc  pdf
​Appendix 7A 07/2015​ ​Youth Advisory Council Handbook doc  pdf
​Appendix 7B 10/2012​ ​Application for KYAC Membership doc  pdf
​Appendix 7C 01/2020​ ​National Youth in Transition Database doc  pdf
​Appendix 7C Definitions ​01/2020 ​Federal Question Definitions doc  pdf
Appendix 7D​ ​01/2015 Kansas Foster Youth Rights Brochure​ pdf
​Appendix 7E 07/2020 ​Checking and Clearing Credit History for Youth doc  pdf
Appendix 7F​ ​01/2015 ​Certification for Identification Card pdf
Appendix 7H​ ​07/2015 ​Mentor Application Packet doc  pdf
​Appendix 9A 10/2019 ​Home Study Guideline doc  pdf
​Appendix 9B 10/2012​ ​ICPC Supervision Report-90 Days doc  pdf
​Appendix 9C 10/2012​ ​ICPC Supervision Report-30 Days doc  pdf
Appendix 9D​ 07/2015​ ​Interstate Compact on the Placement of Children Articles and Regulations doc  pdf
​Appendix 9E ​01/2013 ​ICPC Residential Supervision Report doc  pdf
Appendix 9F​ ​07/2014 ​ICPC Medial Card Process xls   pdf
Appendix 9G​ ​07/2013 ​Sample Reg 7 Court Order doc  pdf
Appendix 9H​ ​07/2014 ​ICPC Referral Checklist doc  pdf
​Appendix 9I ​07/2016 ​Interstate Compact on Adoption and Medical Assistance doc  pdf
Appendix 10A​ ​10/2012 ​Adult Protective Services Statutes doc  pdf
​Appendix 10B ​07/2016 ​APS Guidelines to consider when making a finding doc  pdf
​EP Appendix A ​​ ​Kansas AFDC Needs Standards doc  pdf ​ 
​EP Appendix B 10/2012​ ​Computer Systems doc  pdf
​EP Appendix D 08/2016 ​Computer Systems-WARDS Users Handbook doc  pdf