When families in Kansas take on the noble responsibility of becoming permanent custodians to a child, they may at times encounter the PPS 6180 form, a critical document issued by the State of Kansas Department for Children and Families as of July 2016. This form serves as a Permanent Custodianship Subsidy Repayment Agreement, designed for situations where an overpayment of the subsidy has occurred. The form requires custodian(s) to provide detailed information, including the child's name, date of birth, social security number, along with the custodian's contact details. Importantly, the document outlines an agreement for the custodian(s) to repay the overpayment amount to the Kansas Department for Children and Families, specifying the monthly payment amount and schedule. The signatures of all participating custodians are needed to validate the agreement, accompanied by clear instructions on the payment method and the address for mailing payments. It underscores the importance of fulfilling the repayment obligation; failure to do so could lead to a breach of the agreement and might prohibit future repayment arrangements, aside from initiating other collection actions. This form emphasizes the legal and financial responsibilities that come with permanent custodianship, ensuring that overpayments are addressed and resolved in a structured fashion.
Question | Answer |
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Form Name | Form Pps 6180 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | 2003, 1st, pps 6180 code, DCF |
State of Kansas |
PPS 6180 |
Department for Children and Families |
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Prevention and Protection Services |
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Permanent Custodianship Subsidy Repayment Agreement |
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Case Number: |
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Child’s Name: |
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(First, MI, Last: |
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______________DOB: |
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_________ SSN: |
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_____________ |
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Custodian’s Name: |
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_____________________ |
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Street Address: |
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________________________________________ ________ ___ |
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_________________________________ |
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Mailing Address (Street, City, State, Zip Code) |
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Telephone# (Home): |
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_____________________ (Work): |
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______________________ |
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Email: |
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________________________________________ |
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I/We, (Permanent custodian name(s)): |
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_____________ and |
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__________________, |
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voluntarily agree to repay my Permanent Custodianship Subsidy overpayment balance of
$____ to the Kansas Department for Children and Families.
I/We agree to make monthly payments of $ |
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__per month for |
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consecutive months to |
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complete repayment of the debt. The first payment will be postmarked by |
_____. |
All |
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remaining payments will be postmarked by either (check one): |
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1st of each month, or |
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20th of each month. |
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__________________ |
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_______________ ____ |
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Signature of Permanent Custodian |
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__________________ |
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Signature of Permanent Custodian |
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Date |
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Make checks payable to: Kansas Department for Children and Families (DCF)
Mail this form with the payments to: DCF Central Collection Unit, P.O. Box 2003, Topeka, KS
If you have questions please contact the DCF Central Collection Unit at
ATTENTION: Failure to return this completed agreement with your initial payment, or failure to complete all payments as agreed above, will result in a breach of this agreement and a forfeiture of any future opportunities or agreements to prevent other collection action.
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State of Kansas |
PPS 6180 |
Department for Children and Families |
July 2015 |
Prevention and Protection Services |
Page 2 of 2 |