Kansas Csfp Complaint Form PDF Details

Are you having a problem with your Kansas CSFP supplemental food program services? Chances are, if you're reading this blog post, then the answer is yes! Whether it be an issue with food service or quality complaints, unfortunately we all have to deal with frustrations like this at some point. However, the good news is that there are options available to help resolve those issues. Here we will show you how the process works and provide assistance on filing a complaint against these services through the Kansas Complaint Form.

QuestionAnswer
Form NameKansas Csfp Complaint Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameshow to file a complaint against a dcf worker, srs complaint, how to file a complaint against dcf in florida, how to file a complaint against dcfs

Form Preview Example

Kansas CSFP Complaint Form

Does this complaint allege discrimination?

Yes

No

If yes, STOP and complete the Kansas CSFP Civil Rights Discrimination Complaint Form. If no, continue by completing this complaint form. Local Agency shall resolve complaint and report actions to State Agency. Make one (1) copy of this form. Send Original to State; File Copy in Local Agency Complaint File.

 

 

LOCAL AGENCY FILING REPORT INFORMATION

Date Complaint Received by LA:

 

 

 

Date Complaint Sent to SA:

 

LA Staff Name & Title who received and is Reporting Complaint:

 

Phone: (

)

 

LA Name:

 

 

 

 

 

 

 

 

 

LA Address:

 

 

 

 

 

 

 

PERSON/ORGANIZATION NAMED IN COMPLAINT

 

Person Named in Complaint:

 

 

 

 

 

 

Organization Named in Complaint:

 

Phone: ( )

 

 

 

 

 

 

 

 

 

Person/Organization Street Address:

 

City & Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLAINANT INFORMATION

 

 

 

Identity of Person/Organization making the complaint:

Participant

Vendor

Staff

Other

______________

 

 

 

 

 

 

 

 

 

Complainant Name:

 

 

 

 

 

 

 

Complainant Street Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

 

Complainant City & Zip Code:

 

 

 

(if available)

 

 

Date of problem:

 

 

Description of the problem. (Use additional sheets as needed.)

 

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(OVER)

Rev 3/2006

A-14, Pg. 1

LA Action Taken. (Use additional sheets as needed.)

Signature/Title/Date:

 

 

FOR STATE AGENCY USE ONLY.

 

 

 

 

 

 

 

 

 

 

 

Staff Agency Staff Assigned:

 

Date:

 

 

 

 

 

 

 

 

 

Follow-up (Use additional sheets as needed):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Submit original complaint form to State Agency.

Retain a copy of the complaint in agency Complaint File.

Rev 3/2006

A-14, Pg. 2

How to Edit Kansas Csfp Complaint Form Online for Free

If you want to fill out srs complaint, there's no need to download any sort of software - just make use of our PDF tool. The tool is consistently updated by us, acquiring powerful features and growing to be even more convenient. Here's what you would need to do to get started:

Step 1: Firstly, access the pdf tool by clicking the "Get Form Button" at the top of this site.

Step 2: With this online PDF tool, you can actually do more than just complete blank fields. Try all of the functions and make your documents look great with customized textual content put in, or optimize the original content to perfection - all backed up by the capability to add almost any photos and sign the file off.

This PDF will require particular data to be typed in, so you must take some time to fill in what's requested:

1. To start with, once filling in the srs complaint, start out with the page that features the next blanks:

Part number 1 in submitting dcfs complaint

2. Once your current task is complete, take the next step – fill out all of these fields - Complainant Name, Complainant Street Address, Complainant City Zip Code, Phone if available, Description of the problem Use, and Date of problem with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The way to fill out dcfs complaint part 2

3. The following portion is all about Date of problem, Rev, OVER, and A Pg - fill in all these blanks.

Date of problem, Rev, and A Pg of dcfs complaint

Be extremely attentive while completing Date of problem and Rev, since this is the section where many people make errors.

4. To go ahead, your next stage will require typing in several blank fields. Examples include LA Action Taken Use additional, which you'll find fundamental to moving forward with this document.

LA Action Taken Use additional, LA Action Taken Use additional, and LA Action Taken Use additional of dcfs complaint

5. This very last step to finish this form is integral. Make certain you fill out the mandatory blanks, including SignatureTitleDate, FOR STATE AGENCY USE ONLY, Staff Agency Staff Assigned, and Date, prior to finalizing. In any other case, it could contribute to an incomplete and probably unacceptable form!

dcfs complaint conclusion process described (stage 5)

Step 3: Proofread what you've inserted in the form fields and then click the "Done" button. Join us now and instantly get access to srs complaint, ready for download. Every last edit made is handily saved , helping you to customize the document later if required. Here at FormsPal.com, we do our utmost to guarantee that your information is stored protected.