Form Pps 5928 PDF Details

The State of Kansas Department for Children and Families (DCF) has developed a comprehensive form, PPS 5928, aimed at integrating various aspects of child welfare reporting. This form plays a crucial role in updating and maintaining the health and safety of children under the care of the Department, providing a structured way to report changes in the claimant's situation including but not limited to payee changes, placement adjustments, income variations, and schooling details. By meticulously capturing details such as the claimant's name, date of the report, reporter's name and position, and specifics about any changes such as the new payee's information or changes in the placement of a child, the form enables accurate tracking and timely interventions. Additionally, it addresses the financial aspects related to the care of the children, including expenses incurred, changes in cost of care, and adjustments in Social Security Income (SSI) funding sources, ensuring that the economic factors affecting the welfare of the children are promptly dealt with. With provisions to report on essential changes and requests, including those leading up to when a client nears age 18, the form also prompts considerations for the transition into independent living, making it an essential instrument for the structured and effective management of child welfare within the state.

QuestionAnswer
Form NameForm Pps 5928
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesstudent dcf bengali meaning, student dcf, dcf full form in bengali, dcf full form

Form Preview Example

State of Kansas

Department for Children and FamiliesDCF GSO Reporting Form Prevention and Protection Services

Attn:

DCF eData Reporting Form

PPS 5928 Aug 2012

 

 

Claimant’s Name:

 

Date of Report:

 

 

 

 

 

 

Reporter’s Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

Position:

 

 

 

Social Security Number:

 

 

 

 

 

 

 

 

 

 

 

Location:

 

 

Parent’s SSA Claim Number:

 

 

 

 

 

 

 

 

 

Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAX Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payee Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to: Choose One

Date of Change:

 

 

 

 

 

 

Payee’s Phone:

 

 

 

Name of New Payee:

 

 

 

 

 

 

 

 

 

 

Address of New Payee:

 

 

 

 

 

 

 

 

Best Time to Call:

 

 

 

Reason for Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Placement Change:

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Old Placement Name:

 

 

 

 

 

 

 

 

Old Type:

Choose One

 

 

Old Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Placement Name:

 

 

 

 

 

 

 

 

New Type: Choose One

 

 

New Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cost of Care:

 

 

 

 

 

 

Unit:

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSI Funding Source: Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income Change:

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type:

 

 

Choose One

 

 

Choose One

 

 

 

 

 

Monthly Amnt:

 

 

 

 

 

 

 

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resource Change:

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reason:

 

 

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Change:

Attending?

 

 

Choose One

 

Effective Date:

 

Name & Address of School:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DCF: For clients 17-1/2 complete and mail back the Student Report when received.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Changes:

Type:

 

 

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Multi-Month Distribution

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Request:

Date of Deposit:

 

 

 

 

Amount:

 

 

 

 

 

 

 

 

Requested Dates:

From:

 

 

 

 

 

 

To:

 

 

 

 

 

 

Expenses Incurred: (see attached) DCF: Ask for an expense report from SCRIPTS Average Monthly cost of care:

Is client nearing age 18?

Yes

 

If yes, has the need to conserve these

No

funds for IL been considered?

Yes

No

Additional Comments:

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