The Economic and Employment SERVICES Manual  07-17
APPENDIX

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ALIEN INFORMATION - A

Item Number

Revised
Date

PROGRAM SECTION

File
Format

A-1

01-17

Immigrant Status/Program Qualification Chart

  

PDF

A-2

05-03

Guidance on Noncitizen Verification (Food Assistance Program)

 

  

PDF

A-4

10-16

SSA 40 Qualifying Quarters: User Instructions, Consent for Release of Information (SSA-3288) (linked in document), Request for Quarters of Coverage History Based on Relationship (SSA-513), Request to Resolve Questionable Quarters of Coverage (SSA-512)

 

PDF

A-10

 

 

A-11

INS Class of Admission Codes

PDF

A-12

01-10

Citizenship and Identify Verification For Medical Assistance and General Assistance

 

  

PDF

           

APPEALS/CLAIMS/DISQUALIFICATIONS/LEGAL - B

Item Number

Revised
Date

PROGRAM SECTION

File
Format

B-1

05-14

Food Assistance Disqualification Consent Agreement

 

PDF

B-3

05-15

TANF and Child Care Disqualification Consent Agreement

 

PDF

B-4

03-14

Motion to Dismiss

 

  

PDF

B-5

01-17

Appeal Summary

DOC

  

PDF

B-6

05-16

Request for Trust/Annuity Clearance

 

  

PDF

B-7

05-13

Overpayment Checklist

XLS

 

 

CHILD CARE - C

Item Number

Revised
Date

PROGRAM SECTION

File
Format

C-10

07-16

Child Care Provider Handbook (ES-1655)

 

  

C-10S

01-17

Child Care Provider Handbook
(ES-1655) (Spanish)

 

C-11

10-16

The Parent - Provider Partnership Handbook
(ES-1656)

 

  

C-11S

01-07

The Parent - Provider Partnership Handbook
(ES-1656) (Spanish)

 

C-12

04-13

Regulated Provider Enrollment (ES-1650)

 

  

C-12S

04-13

Regulated Provider Enrollment (ES-1650) (Spanish)

  

C-13

03-14

Unregulated Provider Enrollment (ES-1651)

 

  

C-13S

03-14

Unregulated Provider Enrollment (ES-1651) (Spanish)

  

C-14

07-15

In-Home Child Care Request (ES-1652)

 

  

C-14S

07-15

In-Home Child Care Request (ES-1652) (Spanish)

 

  

C-15

03-14

Out of Home Relative Provider Enrollment
(ES-1653)

 

  

C-15S

03-14

Out of Home Relative Provider Enrollment
(ES-1653) (Spanish)

 

C-18

01-16

Maximum Hourly Child Care Provider Rate Schedule

 

  

PDF

C-19

07-02

Policy Statement on Discipline

 

C-19S

07-02

Policy Statement on Discipline (Spanish)

 

  

C-20

10-03

Turn Around Communication

 

  

PDF

C-25

08-14

Child Care Checklist

DOC

  

PDF

C-26

09-11

Referral for Child Care Provider Enrollment Application

 

 

PDF

C-27

06-16

EHS/Child Care Partnership Checklist

 

 

PDF

DIRECTORIES - D

Item Number

Revised
Date

PROGRAM SECTION

File
Format

D-1

07-16

CACFP Brochure with Sponsors of Child Care Homes

 

  
 

See Web Links for other Directories
           

SELF-SUFFICIENCY - E

Item
Number

Revised
Date

PROGRAM SECTION

File
Format

E-2

05-16

Income and Support Plan II

DOC

  

 

E-4

07-16

TANF 24 Month Limit Questions

 

  

E-6

05-15

Self-Assessment Form

 

 

PDF

E-6S

05-15

Self-Assessment Form (Spanish)

 

  

PDF

E-8

10-15

Self-Sufficiency Agreement

 

  

PDF

E-8S

10-15

Self-Sufficiency Agreement (Spanish)

 

 

PDF

E-9

05-03

Work Experience Procedure/Best Practice

 

 

PDF

E-10

05-16

Comparison of TANF and FS E&T Employment Services

 

  

PDF

E-11

10-14

Education/Training Assistance Desk Aid

DOC

  

PDF

E-12

05-17

EES Screening Tool for Referral to Rehabilitation Services

 

  

PDF

E-14

05-16

Work Program Assessment Protocol

 

  

PDF

E-17

02-07

Community Service Procedure/Best Practice

 

  

PDF

E-18

03-10

Orientation to the World of Work

 

  

PDF

E-19

12-07

Work Site Supervisor's Handbook

 

  

PDF

E-23 12-11 Diversion Payment Option Decision Tree    

PDF

E-24

07-16

Diversion Payment Option Process Flow

 

 

PDF

E-25

07-15

State Work Program Orientation

 

 

PPSX

E-26

07-16

Food Assistance Work Registration Requirements

    

PDF

FINANCIAL STANDARDS - F

Item Number

Revised
Date

PROGRAM SECTION

File
Format

F-1

05-17

Monthly Family Income and Family Share Deduction Schedule for Child Care Services

 

  

F-2

10-16

Food Assistance Program Standard

DOC

  

F-3

10-16

Food Assistance Program Benefit Tables

 

  

F-4

07-11

TABLE I - TANF NonShared Living

 

  

F-5

10-99

TABLE II - TANF Shared Living

HTML

F-11

10-16

130% Income Reporting Chart for Simplified Reporters

 

  

PDF

  

MEDICAID - M

Item
Number

Revised
Date

PROGRAM SECTION

File
Format

M-1

10-99

Statement of Intent to Return Home

 

  

M-2

10-99

Notice of Intent to Transfer Resources

PDF

M-3

10-99

Notice of Intent to Allocate Income

PDF

M-4

10-99

Spousal Impoverishment Allowances Memorandum

 

PDF

M-5

10-99

Medicaid Transfer of Property Decision

 

PDF

M-6

07-12

Medicaid Online Application Signature Page

 

 

PDF

M-7

07-12

Cover Letter for Unsigned Online Applications

DOC

 

 

PROGRAM HELPS - P

Item Number

Revised
Date

PROGRAM SECTION

File
Format

P-1

07-17

Medically Necessary Items Which are Allowable Deductions for Food Assistance or Can be Applied Toward a Spenddown

 

  

P-2

10-05

Statement of Medically Necessity

 

P-3

05-15

Protective Payment Agreement
Attachment

 

P-4

05-17

Kelley Blue Book User Instructions

 

P-5

01-03

Statement of Common-Law Marriage

 

  

P-6

01-05

Landlord Letter

 

  

P-7

10-07

Declaration of Identity - Child

 

  

PDF

P-8

07-06

Declaration of Citizenship

 

  

P-9

10-07

Declaration of Identity - Disabled Adult

 

  

P-11

03-15

Authorization for Release of PHI

 

  

PDF

P-15 05-17 Application Signature Request DOC    

REFERRALS - R

Item
Number

Revised
Date

PROGRAM SECTION

File
Format

R-1

01-13

Medical Subrogation Referral - Adoption

 

  

PDF

R-2

01-13

Medical Subrogation Referral - Injury

 

  

PDF

R-4

07-12

EES/RS Coordination Procedure/Best Practice

 

  

PDF

R-5

05-04

EES/RS Monthly Communication Report:

 

  

PDF

 

TABLES/CHARTS - T

Item Number

Revised
Date

PROGRAM SECTION

File
Format

T-1

05-16

Components to Meet Work Requirements/ Participation

 

  

T-2

04-12

County Group Assignments Chart

 

  

PDF

T-3

05-07

Life Estate Valuation Tables

 

  

PDF

T-4

07-09

Life Expectancy Tables

    

PDF

T-5

`

RESERVED

 

  

T-6

05-17

Relationship Chart (For TANF Only)

 

  

PDF

T-10

05-10

Food Assistance Shelter Changes Chart

 

  

PDF

T-12 10-09 Retirement Accounts Excluded From Resources by the Food and Nutrition Act of 2008    

PDF

T-13

10-15

Under development: Review Type Matrix

 

 

 

EBT - V

Item Number

Revised
Date

PROGRAM SECTION

File
Format

V-1

02-16

Electronic Benefit Transfer System Guide

 

  

V-2

06-13

EBT Brochure - Cash/FS (English)

  

V-3

06-13

EBT Brochure - Cash/FS (Spanish)

  

V-4

06-13

EBT Brochure - Child Care (English)

  

V-5

06-13

EBT Brochure - Child Care (Spanish)

  

V-6

06-13

EBT Brochure - Card Carrier

 

 

PDF

 WORKSHEETS - W

W-1

10-99

Costs of Goods Sold (Attachment)

  

W-2

07-16

Daily Business Log Sheet

 

  

W-7

02-94

Self-Employment Worksheet

  

W-8

01-01

SSI Eligibility Determination Worksheet (Electronic)

 

  

W-9

07-17

Transfer of Property Worksheet

 

  

W-10

05-08

Annuity Evaluation Worksheet

 

  

W-12

07-09

Fair Labor Standard Act (FLSA) Calculation Table

XLS

 

PDF

W-13 01-16

Child Care Plan Hours Worksheet (Instructions)

XLS    
W-14 11-13 MediKan Eligibility Worksheet XLS    

W-15

04-15

VA Potential Benefits Checklist

DOC

 

PDF

W-16 10-15 Patient Liability Worksheet XLS    
W-17 10-15 Reasonable Compatibility Tool XLS    
W-18 10-15 Under development: Review Reactivation Tool      
         

MISCELLANEOUS - X

Item
Number

Revised
Date

PROGRAM SECTION

File
Format

X-1

05-05

Abbreviations & Acronyms Used by KS DCF See Web Links

 

X-2

04-09

An Expanded Definition of "Eligible Foods"
See SNAP Eligible Food Items

 

X-3

05-07

Appointment of Authorized Agent

 

  

PDF

X-5

12-15

Back of Notices of Action

 

  

X-6

07-17

Definitions of Common Terms

 

  

X-7

04-16

Safeguarding Federal Tax Information

 

X-8

11-13

ICT CHECKLIST

    

X-9

10-99

Concerns About A Case Received in Transfer from XX County

 

X-13

12-15

USDA Nondiscrimination Statement

 

 

PDF