Lynne A. Valenti
Cabinet Secretary

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Forms and Publications

The Department of Social Services has free forms and publications that can provide you with information and guidance in a number of important areas.

This page can help you find the information you need in the following ways:

  Order Online Some forms are available to fill out and submit online. The remaining online forms can be filled out on your computer, printed and mailed.
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If you would like to order any form or publication in Spanish, please click on Documentos en Español. You will find both forms and publication in Spanish in this section. The shopping cart will automatically default to the Spanish version of the form or publication.

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Forms and Publications Filter:

Document Type: Forms Only | Publications Only | Documentos en Español | All

Service Area:

Abuse and Neglect

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/ASA2Abuse, Neglect & Exploitation of Elders or Adults with Disabilitiesn/an/an/aenglish versionadd to cart
BRO/CPS11Central Registry of Child Abuse & Neglectn/an/aspanish versionenglish versionadd to cart
BRO/CPS4Mandatory Reporting of Child Abuse & Neglect Brochuren/an/aspanish versionenglish versionadd to cart
BRO/CPS8Help Stop Child Abuse & Neglect Insertn/an/aspanish versionenglish versionadd to cart
CPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)n/aonline versionn/aenglish versionadd to cart
CPS-593Permission to Screen for Reports of Abuse or Neglectn/aonline versionspanish versionenglish versionadd to cart

Administrative Hearings

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/DSS3Administrative Hearings Brochuren/an/an/aenglish versionadd to cart
DSSGuide to Administrative Hearings Proceduren/an/an/aenglish versionadd to cart
EA-319Request for Administrative Hearingn/an/an/aenglish versionadd to cart

Adoption and Foster Care

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/CPS5What I Should Know About Foster Caren/an/aspanish versionenglish versionadd to cart
BRO/CPS9Adoption Subsidy Handbookn/an/an/aenglish versionadd to cart
CPSBackground Information for Voluntary Termination of Parental Rightsn/an/an/aenglish versionadd to cart
CPS-506Foster/Adoptive Parent Health Reportn/an/an/aenglish versionadd to cart
CPS-508Reference Form - Adoption / Foster / Kinship Caren/aonline versionn/aenglish versionadd to cart
CPS-533Adoption Registry Forminstructionsonline versionn/aenglish versionadd to cart
CPS-565Foster Parent Training & Self-Instructionn/aonline versionspanish versionenglish versionadd to cart
CPS-566Foster Parent Evaluationn/aonline versionspanish versionenglish versionadd to cart
CPS-594Declaration of Prior Criminal Conviction & Military Historyn/aonline versionn/aenglish versionadd to cart

Assisted Living and Nursing Homes

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/ASA7Ombudsman Services Brochuren/an/an/aenglish versionadd to cart
BRO/ASA8Assisted Living Centers: Residents Bill of Rights Handbookn/an/an/aenglish versionadd to cart
MISC/ASA6Assisted Living in SD: A Consumers Guiden/an/an/aenglish versionadd to cart
MISC/ASA8Long-Term Care Facilities: Residents Bill of Rights Handbookn/an/an/aenglish versionadd to cart

Behavioral Health

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BH - 01Federal Poverty Level Guidelinesn/aonline versionn/aenglish versionadd to cart
BH - 02Financial Eligibility Formn/aonline versionn/aenglish versionadd to cart
BH - 03102a Hardship Considerations n/aonline versionn/aenglish versionadd to cart
BH - 04102b Hardship Considerationsn/aonline versionn/aenglish versionadd to cart
BH - 05Hardship Considerations Refusaln/aonline versionn/aenglish versionadd to cart
BH - 063rd Party Release of Information (ROI)n/aonline versionn/aenglish versionadd to cart
BH - 07Mental Health - Accreditation Applicationn/aonline versionn/aenglish versionadd to cart
BH - 08Mental Health - IMPACT Applicationn/aonline versionn/aenglish versionadd to cart
BH - 09Mental Health - Indigent Medication Applicationn/aonline versionn/aenglish versionadd to cart
BH - 10Mental Health - Intensive Family Services (IFS) Applicationn/aonline versionn/aenglish versionadd to cart
BH - 11Mental Health - Adult Outcome Toolinstructionsonline versionn/aenglish versionadd to cart
BH - 12Mental Health - Youth Outcome Toolinstructionsonline versionn/aenglish versionadd to cart
BH - 13Mental Health - Family Outcome Toolinstructionsn/an/aenglish versionadd to cart
BH - 14Substance Abuse - Accreditation Applicationn/aonline versionn/aenglish versionadd to cart
BH - 15Substance Abuse - Keystone Meth Agreementn/aonline versionn/aenglish versionadd to cart
BH - 16Substance Abuse - TB Risk Assessment Worksheetn/aonline versionn/aenglish versionadd to cart
BH - 17Prevention - Accreditation Applicationn/aonline versionn/aenglish versionadd to cart
BH - 18Mental Health - Indigent Medication Update - Extension Form 1.0n/aonline versionn/aenglish versionadd to cart
Bh - 19Substance Abuse – Placement Applicationn/aonline versionn/an/an/a

Child Care Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/CCS14Choosing Child Care Handbookn/an/an/aenglish versionadd to cart
BRO/CCS3Registration & Licensure of Child Care Environmentsn/an/an/aenglish versionadd to cart
BRO/CCS6Child Care Assistance Program Brochuren/an/an/aenglish versionadd to cart
CCSPathways to Professional Development - Career Lattice Application Formn/an/an/aenglish versionadd to cart
CCSFoster Care Child Care Applicationn/aonline versionn/an/an/a
CCSPathways to Professional Developmentn/an/an/aenglish versionadd to cart
CCSSouth Dakota Child Safety Seat Distribution Programn/an/an/aenglish versionadd to cart
CCSElectronic Payment Exemptionsn/an/an/aenglish versionadd to cart
CCSPayment Authorization Formn/an/an/aenglish versionadd to cart
CCS-950Child Care Assistance Applicationn/aonline versionn/aenglish versionadd to cart
CCS-970Child Care Services Request For Paymentn/an/an/aenglish versionadd to cart
DSS-CCSRate Declaration Formn/an/an/aenglish versionadd to cart
PosterRecommendations for Exclusion from the Child Care Setting Postern/an/an/aenglish versionadd to cart
PosterReportable Disease List Postern/an/an/aenglish versionadd to cart

Child Protection Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/CPS1Child Protection Services Bookletn/an/aspanish versionenglish versionadd to cart
BRO/CPS3Safe Havens Brochuren/an/aspanish versionenglish versionadd to cart
BRO/CPS7Independent Living Program Education and Training Voucher Brochuren/an/an/aenglish versionadd to cart
CPSICPC Financial and Medical Plann/an/an/aenglish versionadd to cart
CPSPotential Placement Statementn/an/an/aenglish versionadd to cart
CPSPlacement Resource Monthly Reporting Form Ages 0-4n/an/an/aenglish versionadd to cart
CPSPlacement Resource Monthly Reporting Form Ages 14 and oldern/an/an/aenglish versionadd to cart
CPSPlacement Resource Monthly Reporting Form Ages 5-13n/an/an/aenglish versionadd to cart
CPSProvider Mileage Requestn/an/an/aenglish versionadd to cart
CPSIndependent Living Program Education and Training Voucher instructionsn/an/aenglish versionadd to cart
CPSBackground Information for Voluntary Termination of Parental Rightsn/an/an/aenglish versionadd to cart
CPSIndependent Living Program Brochuren/an/an/aenglish versionadd to cart
CPSDesignated Tribal Agent Request Formn/an/an/aenglish versionadd to cart
CPSDesignated Tribal Agent Request for Change of Addressn/an/an/aenglish versionadd to cart
CPSResidential Care Directoryn/aonline versionn/an/an/a
CPS-500Newborn Medical Report for Voluntary Termination of Parental Rightsn/aonline versionn/aenglish versionadd to cart
CPS-522Request for Paymentn/aonline versionn/aenglish versionadd to cart
DSS-CPSSafe Havens Postern/an/an/aenglish versionadd to cart
FACISInterstate Compact: Placement Request Forminstructionsonline versionn/aenglish versionadd to cart
FACISInterstate Compact: Report on Child Placementinstructionsonline versionn/aenglish versionadd to cart

Child Support

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/DCS1Child Support Modification Handbookn/an/aspanish versionenglish versionadd to cart
BRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your Childn/an/an/aenglish versionadd to cart
BRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Incomen/an/an/aenglish versionadd to cart
BRO/DCS4National Medical Support Notice Brochure - An Employers Guiden/an/an/aenglish versionadd to cart
BRO/DCS6Voluntary Paternity Establishment Handbook and Formn/an/aspanish versionenglish versionadd to cart
BRO/DCS8Child Support Parent Handbookn/an/aspanish versionenglish versionadd to cart
SE-405Application for Wage Withholding Only Servicesn/an/an/aenglish versionadd to cart
SE-406Application for Location Only Servicesn/an/an/aenglish versionadd to cart
SE408CPApplication and Agreement for Services - Custodial Parent and/or Relative Caretakern/an/an/aenglish versionadd to cart
SE408NCPApplication and Agreement for Services - Non-Custodial Parent n/an/an/aenglish versionadd to cart
SE-415Petition for Modification Formn/an/an/aenglish versionadd to cart
SE-431AChild Support Payment Authorization Formn/an/an/aenglish versionadd to cart
SE-492Notice of Shared Medical Expensesn/an/an/aenglish versionadd to cart

Domestic Violence

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/ASA4Sexual Assault Brochuren/an/an/aenglish versionadd to cart
BRO/ASA9Domestic Violence Brochuren/an/an/aenglish versionadd to cart

Elderly Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
ASACaregiver Self Assessmentn/an/an/aenglish versionadd to cart
ASAMake a Referraln/aonline versionn/an/an/a
ASAGuide to Medicare, Medicare Supp Insurance and Beneficiary Resourcesn/aonline versionn/an/an/a
ASA-522Request for Paymentn/an/an/aenglish versionadd to cart
ASA-634Provider Forms: Initial and Continuing Need for Care Reportn/aonline versionn/aenglish versionadd to cart
ASA-659Physician Report - Ordern/an/an/aenglish versionadd to cart
ASA-668Homemaker Services Reportn/an/an/aenglish versionadd to cart
ASA-677Application Assistance Form for Medicationsn/aonline versionn/an/an/a
ASA-694Crime Victims Compensation Applicationn/an/an/aenglish versionadd to cart
BRO/ASALong-Term Care Partnership Fact Sheetn/an/an/aenglish versionadd to cart
BRO/ASAHelping You Understand Medicare & Your Benefitsn/an/an/aenglish versionadd to cart
BRO/ASALong-Term Care Partnership Brochuren/an/an/aenglish versionadd to cart
BRO/ASALong-Term Care Partnership Stuffern/an/an/aenglish versionadd to cart
BRO/ASA1Aging & Disability Resource Connections (ADRC)n/an/an/aenglish versionadd to cart
BRO/ASA11Crime Victims Compensation Brochuren/an/an/aenglish versionadd to cart
BRO/ASA2Abuse, Neglect & Exploitation of Elders or Adults with Disabilitiesn/an/an/aenglish versionadd to cart
BRO/ASA3Adult Services and Aging Programs Handbookn/an/aspanish versionenglish versionadd to cart
BRO/ASA5Legal Services for the Elderly Brochuren/an/an/aenglish versionadd to cart
EA-240Medical Assistance for Individuals in Adult Foster Care Facilitiesinstructionsonline versionn/aenglish versionadd to cart

General

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/EA11Weatherization Assistance Brochuren/an/aspanish versionenglish versionadd to cart
BRO/EA12Energy Assistance Brochuren/an/aspanish versionenglish versionadd to cart
EAWeatherization Applicationn/an/aspanish versionenglish versionadd to cart
EA-297Energy Assistance Applicationinstructionsn/aspanish versionenglish versionadd to cart
ENERGYVendor Information: Direct Depositinstructionsonline versionn/aenglish versionadd to cart
ENERGY-927Vendor Information: Vendor Claim Forminstructionsonline versionn/an/an/a

General Social Service Documents

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/DSS2Constituent Liaison Services Brochuren/an/an/aenglish versionadd to cart
BRO/DSS8Notice of Privacy Brochuren/an/aspanish versionenglish versionadd to cart
BRO/DSS9DSS Handbookn/an/an/aenglish versionadd to cart
BRO/EACommunity Action Agency Handoutn/an/an/aenglish versionadd to cart
DSSFiling a Discrimination Complaint Brochure and Formn/an/an/aenglish versionadd to cart
DSS-W9W-9 Formn/an/an/aenglish versionadd to cart
EA-301Economic Assistance Applicationn/aonline versionspanish versionenglish versionadd to cart
EA-310Form for Reporting Changesn/an/an/aenglish versionadd to cart
PosterConstituent Liaison Services Postern/an/an/aenglish versionadd to cart

Medical Assistance

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
ASA-677Application Assistance (Medication Assistance)n/an/an/aenglish versionadd to cart
BRO/ASA10Planning for Health Care Decisions: Your Right to Choosen/an/an/aenglish versionadd to cart

Medical Eligiblity

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/EA14Medical Assistance for Children and Familiesn/an/an/aenglish versionadd to cart
BRO/EA16Medical Assistance for Children and Families: IHS Specificn/an/an/aenglish versionadd to cart
BRO/EA3CHIP Brochuren/an/aspanish versionenglish versionadd to cart
BRO/EA5Medicare Savings Program Brochuren/an/an/aenglish versionadd to cart
BRO/EA8Medicaid Spousal Care Handbookn/an/an/aenglish versionadd to cart
BRO/MS1Medical Assistance Program Recipient Handbookn/an/an/aenglish versionadd to cart
EA-208Recipient Forms: Authorization to Release Informationn/an/aspanish versionenglish versionadd to cart
EA-208Authorization to Furnish / Release Informationn/an/aspanish versionenglish versionadd to cart
EA-208Authorization to Furnish / Release Informationn/an/aspanish versionenglish versionadd to cart
EA-208Authorization to Furnish / Release Informationn/an/aspanish versionenglish versionadd to cart
EA-240Application for Long Term Care or Related Medical Assistancen/an/aspanish versionenglish versionadd to cart
EA-269Child Care Expense Billing Informationn/an/an/aenglish versionadd to cart
EA-270Medical Savings Program Applicationn/an/aspanish versionenglish versionadd to cart
EA-320Self-Employment Ledgern/an/aspanish versionenglish versionadd to cart
FSSAChildren and Family Medical Assistance Applicationn/an/an/aenglish versionadd to cart
PosterCHIP Postern/an/an/aenglish versionadd to cart
PosterCHIP Postern/an/an/aenglish versionadd to cart

Medical Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
Recipient Forms: HIPAA Privacy Consent Formn/aonline versionn/aenglish versionadd to cart
BRO/MS1Medical Assistance Program Recipient Handbookn/an/an/aenglish versionadd to cart
BRO/MS3Well-Child Care Brochuren/an/aspanish versionenglish versionadd to cart
BRO/MS4Title XIX Medical Transportation Brochuren/an/an/aenglish versionadd to cart
DSSRecipient Forms: Psychiatric Residential Treatment Facility Referral Formn/an/an/aenglish versionadd to cart
EA-231Recipient Forms: Child Support Enforcement Referraln/aonline versionspanish versionenglish versionadd to cart
EA-249Disabled Children Application / Eligibility Reviewinstructionsn/an/aenglish versionadd to cart
EA-269Recipient Forms: Child Care Expense Billing Informationn/an/an/aenglish versionadd to cart
EA-270Recipient Forms: Medical Savings Program Applicationn/an/aspanish versionenglish versionadd to cart
EA-320Recipient Forms: Self-Employment Ledgern/aonline versionn/aenglish versionadd to cart
MSPrior Authorization Forms: Durable Medical Equipment and Nutritioninstructionsonline versionn/aenglish versionadd to cart
MSPrior Authorization Forms: General Prior Authorization Requestinstructionsonline versionn/aenglish versionadd to cart
MSHysterectomy Acknowledgement of Informationn/an/an/aenglish versionadd to cart
MSProviders: Adult Services & Aging Provider Agreementinstructionsn/an/aenglish versionadd to cart
MSPrior Authorization Forms: Synagis Prior Authorizationn/aonline versionn/aenglish versionadd to cart
MSProviders: NEMT Provider Agreementinstructionsonline versionn/aenglish versionadd to cart
MSProviders: General Provider Agreementinstructionsonline versionn/aenglish versionadd to cart
MSFamily Planning Billing Manualn/an/an/aenglish versionadd to cart
MSHospice Billing Manualn/an/an/aenglish versionadd to cart
MSInstitutional Billing Manualn/an/an/aenglish versionadd to cart
MSLong Term Care Billing Manualn/an/an/aenglish versionadd to cart
MSNutritional Therapy Billing Manualn/an/an/aenglish versionadd to cart
MSPharmacy Billing Manualn/an/an/aenglish versionadd to cart
MSPrior Authorization Manualn/an/an/aenglish versionadd to cart
MSProfessional Services Billing Manualn/an/an/aenglish versionadd to cart
MS-102Provider Selection Formn/aonline versionn/aenglish versionadd to cart
MS-103Provider Change Formn/aonline versionn/aenglish versionadd to cart
MS-146Sterilization Consent Formn/an/an/aenglish versionadd to cart
OS-950Recipient Forms: Title XIX Medical Transportation Reimbursementn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Private Duty Nursing & Extended Home Health Servicesn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Out-of State Services n/an/an/aenglish versionadd to cart

Nutrition

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/ASASenior Meals Brochuren/an/an/aenglish versionadd to cart
PosterSenior Meals Postern/an/an/aenglish versionadd to cart

Parent Education

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/CPS2Common Sense Parenting Brochuren/an/aspanish versionenglish versionadd to cart
CPSCommon Sense Parenting Annual Report Formn/aonline versionn/an/an/a
CPSCommon Sense Parenting Program Vouchern/aonline versionn/an/an/a

Psychiatric Residential Treatment

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
DSSPsychiatric Residential Treatment Facility Referral Formn/an/an/aenglish versionadd to cart

Recoveries and Fraud

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/RE1Stop Benefit Fraud Brochuren/an/an/aenglish versionadd to cart
BRO/RE3Estate Recovery Program Brochuren/an/an/aenglish versionadd to cart
DSS-ORFI-831Estate Recovery Notification of Death Formn/an/an/aenglish versionadd to cart
Rec and FraudEstate Recovery Program Petition for Limitationn/aonline versionn/aenglish versionadd to cart
Rec and FraudReport Benefit Fraudn/aonline versionn/aenglish versionadd to cart
Rec and FraudCasualty Settlement Report Formn/aonline versionn/aenglish versionadd to cart
Rec and FraudStop Benefit Fraud Insertn/an/an/aenglish versionadd to cart
Rec and FraudMedicaid Liens Brochuren/an/an/aenglish versionadd to cart

SNAP (Food Stamps)

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/EA10SNAP for Studentsn/an/an/aenglish versionadd to cart
BRO/EA2SNAP Brochuren/an/aspanish versionenglish versionadd to cart
BRO/EA9SNAP Shoppers Guiden/an/an/aenglish versionadd to cart
EA-214SNAP 6 Month Report Formn/an/aspanish versionenglish versionadd to cart
EA-269Child Care Expense Billing Informationn/an/an/aenglish versionadd to cart
EA-301SNAP Applicationn/aonline versionspanish versionenglish versionadd to cart
EA-305Boarding School-Institution Documentationn/an/an/aenglish versionadd to cart
EA-307SNAP Exit Formn/an/an/aenglish versionadd to cart
EA-307GSNAP Group Home Exit Formn/an/an/aenglish versionadd to cart
EA-320Self-Employment Ledgern/an/aspanish versionenglish versionadd to cart
EA-324Wage Verificationn/an/an/aenglish versionadd to cart
EA-345Affidavit for SNAP Work Registrantsn/an/an/aenglish versionadd to cart
EA-345AAffidavit for SNAP Work Registrants (Employment & Training)n/an/an/aenglish versionadd to cart
EA-347Application for Social Security Numbern/aonline versionn/aenglish versionadd to cart
OS-954Client Authorized Debit for Repayment of Overissuancen/an/an/aenglish versionadd to cart

South Dakota EBT

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/DSS4Direct Deposit Brochuren/an/an/aenglish versionadd to cart
BRO/EBT1EBT Client Handbookn/an/aspanish versionenglish versionadd to cart

Temporary Assistance for Needy Families

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/EA4TANF Work Program Brochuren/an/aspanish versionenglish versionadd to cart
EA-214TANF 6 Month Report Formn/an/aspanish versionenglish versionadd to cart
EA-217Dependent Living Agreementn/aonline versionn/aenglish versionadd to cart
EA-231Child Support Enforcement Referraln/aonline versionspanish versionenglish versionadd to cart
EA-260Statement of Earningsn/aonline versionn/aenglish versionadd to cart
EA-320Self-Employment Ledgern/aonline versionspanish versionenglish versionadd to cart