Form PPS 10370 Ane Unit Cover Sheet' - Kansas

Form PPS10370 or the "Ane Unit Cover Sheet'" is a form issued by the Kansas Department for Children and Families.

The form was last revised in January 1, 2018 and is available for digital filing. Download an up-to-date Form PPS10370 in PDF-format down below or look it up on the Kansas Department for Children and Families Forms website.

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PPS 10370
January 2018
State of Kansas
ANE Unit
Department for Children and Families
Coversheet
Prevention and Protection Services- Adult Protective Services
TYPE or PRINT LEGIBLY
To:
Abuse /Neglect/Exploitation Unit
Fax No:
785-296-6795
Date:
From:
DCF Service Center:
Phone Number:
Email Address:
Incident City & County:
KIPS Investigation #:
CONFIDENTIALITY NOTICE: The materials enclosed with this facsimile transmission are private and confidential and are the property of the sender. The
information contained in the material is privileged and is intended only for the use of the individual(s) or entity(ies) named above. If you are not the intended
recipient, be advised that any unauthorized disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information
is strictly prohibited and may subject you to civil or criminal penalties. If you receive this facsimile transmission in error, please immediately notify the sender by
telephone to arrange for the return of the forwarded documents.
Was Law Enforcement involved in the investigation?
No
Yes (complete below)
Was Law Enforcement forwarded the finding?
No
Yes (complete below)
Name of Law Enforcement Officer:
Law Enforcement Agency:
Police Report Number:
If readily available
Telephone Number:
Finding referred to County/District Attorney:
No
Yes (complete below)
Name of County/District Attorney:
NUMBER OF PAGES (including cover sheet):
Adult report attachments
PPS 10100
PPS 10110
PPS 10120
PPS 10300
A summary of finding from KIPS Notes
PPS 10350
PPS 10250 Corrective Action Plan (if applicable)
Information contained in the attached Adult Protective Services Intake document (PPS 10100) was provided by the individual making the report. The accuracy of
the information has not been verified or confirmed by DCF.
PPS 10370
January 2018
State of Kansas
ANE Unit
Department for Children and Families
Coversheet
Prevention and Protection Services- Adult Protective Services
TYPE or PRINT LEGIBLY
To:
Abuse /Neglect/Exploitation Unit
Fax No:
785-296-6795
Date:
From:
DCF Service Center:
Phone Number:
Email Address:
Incident City & County:
KIPS Investigation #:
CONFIDENTIALITY NOTICE: The materials enclosed with this facsimile transmission are private and confidential and are the property of the sender. The
information contained in the material is privileged and is intended only for the use of the individual(s) or entity(ies) named above. If you are not the intended
recipient, be advised that any unauthorized disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information
is strictly prohibited and may subject you to civil or criminal penalties. If you receive this facsimile transmission in error, please immediately notify the sender by
telephone to arrange for the return of the forwarded documents.
Was Law Enforcement involved in the investigation?
No
Yes (complete below)
Was Law Enforcement forwarded the finding?
No
Yes (complete below)
Name of Law Enforcement Officer:
Law Enforcement Agency:
Police Report Number:
If readily available
Telephone Number:
Finding referred to County/District Attorney:
No
Yes (complete below)
Name of County/District Attorney:
NUMBER OF PAGES (including cover sheet):
Adult report attachments
PPS 10100
PPS 10110
PPS 10120
PPS 10300
A summary of finding from KIPS Notes
PPS 10350
PPS 10250 Corrective Action Plan (if applicable)
Information contained in the attached Adult Protective Services Intake document (PPS 10100) was provided by the individual making the report. The accuracy of
the information has not been verified or confirmed by DCF.

Download Form PPS 10370 Ane Unit Cover Sheet' - Kansas

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