When Used: If KEES pulls the incorrect repayment amount into the generated form.
Special Instruction: Use the V808
We have found that DCF has paid you too much for your child care. The amount you must repay to DCF is *OVERPAYMENT AMOUNT*. Listed below are ways you can repay this amount. Please choose one way by check mark. Return this form within 10 days.
(__) I agree to repay DCF with one payment, in the following manner:
(__) Payment is enclosed (Do Not Send Cash in Mail).
(__) Payment will be made by ________________.
(__) I would like to repay using existing child care benefits on my Kansas
EBT Benefits card.
(__) I cannot repay DCF in one payment. I would like to develop a payment plan with DCF in the following manner:
(__) I agree to repay in monthly installments of $______________
(__) I agree to have my benefits reduced
This overpayment happened because: *REASON*
This action is based on the Kansas Economic and Employment Support Manual.
SIGNATURE:____________________________________ DATE:________________
This overpayment claim number is *CLAIM NUMBER*. If you disagree with this action, you have a right to a Fair Hearing.