Form KDOC-0200 "Placement CAP Exception Request" - Kansas

What Is Form KDOC-0200?

This is a legal form that was released by the Kansas Department of Corrections - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Kansas Department of Corrections;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form KDOC-0200 by clicking the link below or browse more documents and templates provided by the Kansas Department of Corrections.

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Download Form KDOC-0200 "Placement CAP Exception Request" - Kansas

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PLACEMENT CAP EXCEPTION REQUEST
Community Supervision Standard 04-135 requires an exception be approved by KDOC-JS staff for any youth residing in
an out-of-home placement to remain in residential placement for more than 180 days. This form should be completed and
sent via email to
exceptions@doc.ks.gov
30 days prior to the 180 days reintegration date. KDOC-JS staff will reply within
five (5) business days of receipt of this request.
Youth Name:
Age:
Judicial District:
Permanency Goal:
Date of Out-of-Home Placement:
YLS Risk Level:
Exception Justification: (check all that apply) (documentation for each exception must be included upon submission for
any exception)
_____ 1. The youth’s education completion date falls after the 180 days.
_____ 2. The youth’s programming/treatment completion date falls after the 180 days.
_____ 3. The youth’s approved PRTF admission date falls after the 180 days.
_____ 4. The youth’s approved in-patient drug/alcohol date falls after the 180 days.
_____ 5. Other (please specify in the narrative section below)
Additional narrative justifying placement exception request:
By signing below, I acknowledge that it is in the best interest of the youth referenced above to remain in a
residential placement beyond the 180 day maximum.
______________________________
______________________________
__________________
Supervision Officer Name
Supervision Officer Signature
Date
______________________________
______________________________
__________________
Supervision Supervisor Name
Supervision Supervisor Signature
Date
State of Kansas
Kansas Department of Corrections
Form: KDOC-0200
Revised: August 2016
 
 
PLACEMENT CAP EXCEPTION REQUEST
Community Supervision Standard 04-135 requires an exception be approved by KDOC-JS staff for any youth residing in
an out-of-home placement to remain in residential placement for more than 180 days. This form should be completed and
sent via email to
exceptions@doc.ks.gov
30 days prior to the 180 days reintegration date. KDOC-JS staff will reply within
five (5) business days of receipt of this request.
Youth Name:
Age:
Judicial District:
Permanency Goal:
Date of Out-of-Home Placement:
YLS Risk Level:
Exception Justification: (check all that apply) (documentation for each exception must be included upon submission for
any exception)
_____ 1. The youth’s education completion date falls after the 180 days.
_____ 2. The youth’s programming/treatment completion date falls after the 180 days.
_____ 3. The youth’s approved PRTF admission date falls after the 180 days.
_____ 4. The youth’s approved in-patient drug/alcohol date falls after the 180 days.
_____ 5. Other (please specify in the narrative section below)
Additional narrative justifying placement exception request:
By signing below, I acknowledge that it is in the best interest of the youth referenced above to remain in a
residential placement beyond the 180 day maximum.
______________________________
______________________________
__________________
Supervision Officer Name
Supervision Officer Signature
Date
______________________________
______________________________
__________________
Supervision Supervisor Name
Supervision Supervisor Signature
Date
State of Kansas
Kansas Department of Corrections
Form: KDOC-0200
Revised: August 2016
 
 
______________________________
______________________________
__________________
Central Office (or designee) Name
Central Office (or designee) Signature
Date
______________________________
______________________________
__________________
Central Office (or designee) Name
Central Office (or designee) Signature
Date
_____: Approved
_____: Denied
Additional narrative justifying why an exception was denied.
The below is for the appeal process only.
Additional narrative justifying why an appeal is being requested.
______________________________
______________________________
__________________
Central Office (or designee) Name
Central Office (or designee) Signature
Date
_____: Approved
_____: Denied
State of Kansas
Kansas Department of Corrections
Form: KDOC-0200
Revised: August 2016
 
 
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