Pursuant to the requirements of the Paperwork Reduction Act, the IRS has proposed a new form to be used by taxpayers who have received an erroneous refund. The proposed Form Pps 5928 would be used by taxpayers to request that the IRS not process the refund and return it to the taxpayer. The proposed form is 8½ inches wide and 11 inches long with one-half inch margins on all sides. It is designed to be used by taxpayers who have received an erroneous refund or a refund in excess of what they were owed. The form would require taxpayers to provide their name, address, social security number, daytime telephone number, reason for requesting that the refund not be processed, and signature. In addition, the form would require taxpayers to identify the tax year for which they received the erroneous refund and the amount of the erroneous refund. The IRS is seeking comments from stakeholders on this proposed form. Comments may be submitted on or before November 3, 2014. Stakeholders are enco
Question | Answer |
---|---|
Form Name | Form Pps 5928 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | student dcf bengali meaning, student dcf, dcf full form in bengali, dcf full form |
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 |
||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
Other Changes: |
Type: |
|
|
Choose One |
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
|
|
Date of Change: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
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: