ES-005 RETAIN Informed Consent and Privacy Form | RETAINWORKS

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ES-005 RETAIN Informed Consent and Privacy Form

File size: 273.50 KB

Created: 08-11-2023

Updated: 08-11-2023

Hits: 21

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1000 SW Jackson, Suite 100 Topeka, KS 66612

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785-207-3907

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retainworks@ks.gov

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RETAINWORKS is funded by the U.S. Department of Labor and the Social Security Administration under a grant award of $21,600,000 to the Kansas Department of Commerce that will be incrementally provided. 100% of grant funding is from U.S. Federal funds. This website does not necessarily reflect the views or policies of the U.S. Department of Labor or the Social Security Administration, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Equal Opportunity Employer/Program – Auxiliary aids and services are available upon request to individuals with disabilities. Any individual with a disability may request accommodations by contacting the Program Manager at 785-207-3907, TDD: 711 or 1-800-766-3777, retainworks@ks.gov.

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