ECONOMIC & EMPLOYMENT SUPPORT
|
Item Number |
Revised
Date |
PROGRAM SECTION |
File
Format |
ES-524 |
02-17 |
Food Assistance Disqualified Recipient Report |
DOC |
PDF |
ES-1510.1* |
10-20 |
Computation of Food Assistance Benefit Instructions |
XLS |
|
|
ES-1512 |
05-17 |
Change Report Form |
DOC |
PDF |
ES-1512FC |
06-20 |
Changes for Foster Care Child Care Benefits (Spanish) |
|
PDF |
|
ES-1600* |
10-02 |
Civil Rights Complaint |
DOC |
PDF |
ES-1601 |
08-17 |
Affidavit of Identity |
DOC |
|
ES-1603 |
08-17 |
Address Change-Voter Registration Information |
DOC |
|
ES-1610 |
10-20 |
Kansas Early Head Start Child Care Partnerships Referral for Child Care Assistance |
|
PDF |
|
ES-1611* |
12-05 |
Request for DCF Child Care Assistance at Flint Hills Job Corps
Child Development Center |
DOC |
PDF |
|
ES-1627* |
05-18 |
Request for Social Service Child Care |
DOC |
PDF |
ES-1627b* |
07-19 |
Referral for Child Care for Children in Safe Families or Relative or Non-Relative Kinship Foster Care |
DOC |
|
ES-1640 |
07-19 |
Statement of Understanding |
|
PDF |
ES-1640a |
08-14 |
Educational Plan Completion Tracking |
DOC |
PDF |
ES-2007 |
09-19 |
Food Assistance Brochure
|
Insert 2020 |
PDF |
ES-2007S |
09-19 |
Food Assistance Brochure (Spanish) |
Insert 2020 |
PDF |
ES-3100 |
05-20 |
Application for Benefits |
|
PDF |
ES-3100S |
05-20 |
Application for Benefits (Spanish) |
|
PDF |
ES-3100FC |
07-20 |
Application for Foster Care Child Care Benefits (Spanish) |
|
PDF |
ES-3100APS |
12-14 |
Additional Persons (Spanish) |
|
PDF |
ES-3100DT |
06-20 |
Acknowledgement of TANF Suspicion-based Drug Testing Policy (Spanish) (Cover Letter) |
DOC |
PDF |
ES-3100r |
04-20 |
Review Form |
|
PDF |
ES-3100rS |
05-19 |
Review Form For Families (Spanish) |
|
PDF |
ES-3100. 9 |
07-17 |
Grandparents as Caregivers Assistance Application |
|
PDF |
ES-3101* |
05-07 |
Release of Information and Liability |
DOC |
PDF |
ES-3102* |
07-16 |
Important Information About Cooperation |
DOC |
PDF |
ES-3102S* |
07-16 |
Important Information About Cooperation
(Spanish) |
DOC |
PDF |
ES-3103 |
05-19 |
Food Assistance Optional Release of Information |
|
PDF |
ES-3103S |
05-19 |
Food Assistance Optional Release of Information (Spanish) |
|
PDF |
ES-3104.1 |
07-17 |
TANF Benefit Determination Instructions |
XLS |
|
ES-3105.1 |
02-16 |
Request for Information |
DOC |
|
ES-3105.1S |
02-16 |
Request for Information (Spanish) |
DOC |
|
|
ES-3106* |
10-99 |
Notice of Action |
|
PDF |
|
ES-3107* |
08-17 |
Waiver of Timely Notice of Action |
|
PDF |
ES-3108* |
05-18 |
Request for Employment Information |
DOC |
|
ES-3112 |
10-16 |
Referral for an Administrative Disqualification Hearing |
DOC |
PDF |
| |
| |
|
|
|
|
ES-3114 |
04-20 |
Food Assistance Interim Report Form |
|
PDF |
ES-3114S |
10-14 |
Food Assistance Interim Report Form |
DOC |
PDF |
ES-3115* |
04-20 |
12 Month Report Form |
|
PDF |
ES-3115S* |
10-09 |
12 Month Report Form (Spanish) |
DOC |
PDF |
ES-3117 |
08-17 |
Purchase and Prepare Statement |
DOC |
|
ES-3120.5* |
05-18 |
Agency Fraud Referral |
DOC |
|
ES-3141 |
10-14 |
Kansas Benefits Card Request for Alternate Payee |
|
PDF |
ES-3142* |
01-19 |
EBT Benefit Repayment Agreement |
DOC |
PDF |
ES-3143* |
|
Food Assistance Replacement During Household Disasters |
DOC |
PDF |
ES-3144 |
08-17 |
Food Assistance Adjustment Notice |
DOC |
|
ES-3145 |
08-17 |
Kansas Benefits Card-Important notice (FA) |
DOC |
|
ES-3146 |
08-17 |
Kansas Benefits Card-Important notice (CA) |
DOC |
|
ES-3147 |
08-17 |
Restricted Use of TANF Benefits |
DOC |
|
ES-3200 |
01-19 |
Kansas Voter Registration Application |
|
PDF |
ES-3200S |
01-19 |
Kansas Voter Registration Application (Spanish) |
|
PDF |
ES-3148 |
08-17 |
Claim Balance Change-Overpayment Paid with Kansas Benefits Card |
DOC |
|
ES-3500 |
10-20 |
Low Income Energy Assistance Program Application (LIEAP) |
|
PDF |
ES-3500S |
10-20 |
Low Income Energy Assistance Program Application (LIEAP) (Spanish) |
|
PDF |
ES-3501 |
10-18 |
Subsidized Housing Worksheet (Deep Subsidy) |
XLS |
|
ES-3900* |
10-06 |
Tell Us If You Have A Disability |
DOC |
PDF |
ES-4101 |
09-18 |
TANF Months in Kansas |
DOC |
|
ES-4102 |
09-18 |
TANF Request for Months in other States |
DOC |
|
ES-4104* |
05-16 |
Cooperative Work Site Agreement |
DOC |
PDF |
ES-4104.1* |
10-06 |
Work Experience Program Agreement (Addendum) |
DOC |
PDF |
ES-4105* |
05-16 |
Cooperative Community Service Program Agreement |
DOC |
PDF |
ES-4105.1* |
10-06 |
Cooperative Community Service Program Agreement (Addendum) |
|
PDF |
ES-4106 |
07-16 |
Diversion Payment Option Disclaimer |
|
PDF |
ES-4108 |
08-19 |
Collection Site Passport
Collection Sites |
|
PDF |
ES-4302 |
02-18 |
Employer Letter for TANF Samples |
DOC |
|
ES-4303 |
08-17 |
Sample Month Participant |
DOC |
|
ES-4304 |
07-19 |
TANF Work Hours Verification Checklist |
|
XLSM |
ES-4305 |
10-20 |
TANF Sample Cases Review Guide |
|
PDF |
ES-4308* |
07-17 |
Hardship Exemption Calculator |
DOC |
PDF |
ES-4309* |
12-16 |
Drs. Statement |
DOC |
PDF |
ES-4310A* |
03-19 |
Need For Care Adult Medical Documentation |
DOC |
|
ES-4310C* |
03-19 |
Need For Care Child Medical Documentation |
DOC |
|
|
ES-4313* |
07-17 |
Statement of Understanding for Vehicle Purchase |
DOC |
PDF |
|
ES-4314* |
01-07 |
Supervisor Checklist for Vehicle Purchase |
DOC |
PDF |
|
ES-4316* |
07-17 |
Screening/Referral Form |
DOC |
PDF |
ES-4317* |
01-12 |
KHPOP Questionnaire For TANF Customers |
DOC |
|
ES-4322* |
|
Community Service/Work Experience Assignment and Site Report |
DOC |
PDF |
ES-4411* |
05-16 |
Claim for Comparable Coverage |
DOC |
PDF |
ES-4412* |
10-15 |
SRCC EES Referral, Report and Turn-Around Document |
DOC |
|
ES-4413* |
10-18 |
SRCC Monthly Report |
DOC |
PDF |
ES-4415* |
01-20 |
DCF/DSA Monthly Progress Report |
DOC |
|
ES-4416* |
12-20 |
DCF/DSA Referral Form |
DOC |
|
ES-4416S* |
12-20 |
DCF/DSA Referral Form (Spanish) |
DOC |
|
ES-4417 |
01-13 |
DCF/S.A.F.E. Project Referral |
|
PDF |
ES-4418* |
08-15 |
KeyTrain Referral /Turnaround Form |
DOC |
|
ES-6010 |
05-08 |
Becoming A DCF Child Care Provider Brochure |
|
PDF |
ES-6075 |
10-12 |
Solutions Recovery Care Coordination (SRCC) Brochure Spanish |
|
PDF |
ES-6078 |
10-10 |
Partnering For Success Brochure - Work Site Placement |
|
PDF |
|
IS-4308* |
07-17
|
Assessment Referral/Report |
DOC |
PDF |
|
IS-4315* |
07-17
|
EES & RS Referral/Communication Form |
|
PDF |
|